Perioperative Analgesic Interventions and Strategies for Pain Management After Major Orthopedic and Spine Surgery: A Systematic Review

Abstract

Background/Objectives: Postoperative pain remains a major clinical and public health challenge, contributing to delayed recovery, increased opioid use, and risk of chronic postsurgical pain. A variety of postoperative analgesic interventions and strategies, including multimodal analgesia, regional anesthesia, local analgesic techniques, adjunctive pharmacological agents and structured perioperative care pathways have been proposed to improve pain management and reduce opioid exposure. This systematic review evaluated the effectiveness of perioperative analgesic interventions and strategies in major orthopedic and spine surgeries. Methods: The study was registered in PROSPERO and followed the PRISMA guidelines. A comprehensive search was performed to identify controlled trials involving major surgeries. Risk of bias was assessed using Cochrane tools, and the certainty of evidence was evaluated using the GRADE approach. Results: Across 37 included studies, a range of perioperative analgesic interventions and strategies was evaluated. They were associated with reduced postoperative pain or opioid consumption in some studies, whereas other studies reported no significant differences between intervention and control groups. Recovery outcomes and patient satisfaction were generally comparable between groups. Although 20 studies were classified as having a low risk of bias, these results should be interpreted within the context of very low certainty of evidence. Conclusions: Despite the need for studies with long-term follow-up, perioperative analgesic interventions and strategies appear promising for improving postoperative pain control and reducing opioid exposure in major orthopedic and spine surgery without compromising recovery. However, substantial clinical and methodological heterogeneity across interventions, comparators and outcomes limits direct comparisons and prevents conclusions regarding a single optimal analgesic approach.