SUSPENDED CONSCIOUSNESS: A CRITICAL REVIEW OF MULTIMODAL ANALGESIA AND ITS IMPACT ON PAIN PHYSIOLOGY IN HIGH-RISK SURGICAL PATIENTS

Abstract

DOI: https://doi.org/10.46296/gt.v9i17.0344

Abstract

Background: Adequate perioperative analgesia is essential to improve outcomes in major surgery. Poorly controlled postoperative pain is associated with systemic complications, including excessive neuroendocrine activation, delirium, and prolonged recovery (1,2). Thus arises the dilemma between achieving optimal pain control versus avoiding depression of consciousness from sedative drugs. Objective: This critical review analyzes recent evidence on multimodal analgesia—combining regional blocks and intravenous opioids—versus conventional systemic opioid analgesia in patients undergoing major abdominal surgery. We examine the pathophysiology of pain and the neuroendocrine response to surgical trauma, the effects of different anesthetic techniques on the central nervous system, and the ethics of “necessary pain” in anesthesia practice. Methods: We included meta-analyses, clinical trials, and guidelines published in the last 10 years involving humans. Results: Current literature suggests regional analgesic techniques blunt the surgical stress response and reduce cardiorespiratory complications in high-risk patients (4,6). Multimodal analgesia has been associated with lower opioid consumption and lower incidence of postoperative delirium, permitting faster recovery (2,7). However, we discuss conflicting results from recent studies regarding consciousness preservation and long-term outcomes. Conclusions: A balanced, personalized, and ethically informed perioperative analgesic approach can optimize pain control without compromising patient safety or lucidity.

Keywords: Multimodal analgesia; Regional block; Postoperative pain; Postoperative delirium; Neuroendocrine response.