• David Gelman, Arūnas Gelmanas, Dalia Urbanaitė, Ramūnas Tamošiūnas, Saulius Sadauskas, Diana Bilskienė, Albinas Naudžiūnas, Edmundas Širvinskas, Rimantas Benetis, and Andrius Macas.
• Department of Cardiac, Thoracic and Vascular Surgery, Medical Academy Lithuanian University of Health Sciences, Kaunas 50009, Lithuania. gelmanas@gmail.com.
• Medicina (Kaunas). 2018 Apr 23; 54 (2).

AbstractEnhanced recovery after surgery (ERAS) are specially designed multimodal perioperative care pathways which are intended to attain and improve rapid recovery after surgical interventions by supporting preoperative organ function and attenuating the stress response caused by surgical trauma, allowing patients to get back to normal activities as soon as possible. Evidence-based protocols are prepared and published to implement the conception of ERAS. Although they vary amongst health care institutions, the main three elements (preoperative, perioperative, and postoperative components) remain the cornerstones. Postoperative pain influences the quality and length of the postoperative recovery period, and later, the quality of life. Therefore, the optimal postoperative pain management (PPM) applying multimodal analgesia (MA) is one of the most important components of ERAS. The main purpose of this article is to discuss the concept of MA in PPM, particularly reviewing the use of opioid-sparing measures such as paracetamol, nonsteroid anti-inflammatory drugs (NSAIDs), other adjuvants, and regional techniques.

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