Multimodal Analgesia

Postoperative pain can combine inflammatory incisional pain, visceral pain, muscle spasm, and nerve-related pain. A single analgesic cannot address all of these mechanisms without increasing its own toxicity. Multimodal analgesia therefore combines complementary medications and techniques—such as acetaminophen, an NSAID, local or regional anesthesia, and an opioid only when needed—with nonpharmacologic measures. The goal is not pain relief at the cost of profound sedation. The goal is tolerable pain that permits deep breathing, coughing, mobility, sleep, and participation in recovery while limiting opioid exposure. Postoperative pain guidelines support this approach in adults and children. For a Canadian NP, the regimen must be individualized to the procedure, pain phenotype, age, weight, renal and hepatic function, bleeding and cardiovascular risk, respiratory vulnerability, current medications, and local policy. Prescribing and controlled-substance practice must remain within applicable provincial or territorial authority, institutional protocols, and Canadian product monographs.