Postoperative pain management in non-traumatic emergency general surgery: WSES-GAIS-SIAARTI-AAST guidelines
Authors: Coccolini Federico , Corradi Francesco , Sartelli Massimo , Coimbra Raul , Kryvoruchko Igor A. , Leppaniemi Ari , Doklestic Krstina , Bignami Elena , Biancofiore Giandomenico , Bala Miklosh , Marco Ceresoli , Damaskos Dimitris , Biffl Walt L. , Fugazzola Paola , Santonastaso Domenico , Agnoletti Vanni , Sbarbaro Catia , Nacoti Mirco , Hardcastle Timothy C. , Mariani Diego , De Simone Belinda , Tolonen Matti , Ball Chad , Podda Mauro , Di Carlo Isidoro , Di Saverio Salomone , Navsaria Pradeep , Bonavina Luigi , Abu-Zidan Fikri , Soreide Kjetil , Fraga Gustavo P. , Carvalho Vanessa Henriques , Batista Sergio Faria , Hecker Andreas , Cucchetti Alessandro , Ercolani Giorgio , Tartaglia Dario , Galante Joseph M. , Wani Imtiaz , Kurihara Hayato , Tan Edward , Litvin Andrey , Melotti Rita Maria , Sganga Gabriele , Zoro Tamara , Isirdi Alessandro , De’Angelis Nicola , Weber Dieter G. , Hodonou Adrien M. , tenBroek Richard , Parini Dario , Khan Jim , Sbrana Giovanni , Coniglio Carlo , Giarratano Antonino , Gratarola Angelo , Zaghi Claudia , Romeo Oreste , Kelly Michael , Forfori Francesco , Chiarugi Massimo , Moore Ernest E. , Catena Fausto , Malbrain Manu L. N. G. 
Published: September 2022

Abstract
Background
Non-traumatic emergency general surgery involves a heterogeneous population that may present with several underlying diseases. Timeous emergency surgical treatment should be supplemented with high-quality perioperative care, ideally performed by multidisciplinary teams trained to identify and handle complex postoperative courses. Uncontrolled or poorly controlled acute postoperative pain may result in significant complications. While pain management after elective surgery has been standardized in perioperative pathways, the traditional perioperative treatment of patients undergoing emergency surgery is often a haphazard practice. The present recommended pain management guidelines are for pain management after non-traumatic emergency surgical intervention. It is meant to provide clinicians a list of indications to prescribe the optimal analgesics even in the absence of a multidisciplinary pain team.

Material and methods
An international expert panel discussed the different issues in subsequent rounds. Four international recognized scientific societies: World Society of Emergency Surgery (WSES), Global Alliance for Infection in Surgery (GAIS), Italian Society of Anesthesia, Analgesia Intensive Care (SIAARTI), and American Association for the Surgery of Trauma (AAST), endorsed the project and approved the final manuscript.

Conclusion
Dealing with acute postoperative pain in the emergency abdominal surgery setting is complex, requires special attention, and should be multidisciplinary. Several tools are available, and their combination is mandatory whenever is possible. Analgesic approach to the various situations and conditions should be patient based and tailored according to procedure, pathology, age, response, and available expertise. A better understanding of the patho-mechanisms of postoperative pain for short- and long-term outcomes is necessary to improve prophylactic and treatment strategies.