Postoperative Pain Management Strategies Following Peroral Endoscopic Myotomy (POEM): A Review
Jun Lu,1 Wentao Ji,1 Chao Sang,2 Zhi Wang,1 Lulong Bo1 1Department of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, 200433, People’s Republic of China; 2Department of Anesthesiology, Yueyang Hospital of Integrated Traditional and Western Medicine, Shanghai University of Trad...
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Dove Medical Press
2025-05-01
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| Series: | Journal of Pain Research |
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| author | Lu J Ji W Sang C Wang Z Bo L |
| author_facet | Lu J Ji W Sang C Wang Z Bo L |
| author_sort | Lu J |
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| description | Jun Lu,1 Wentao Ji,1 Chao Sang,2 Zhi Wang,1 Lulong Bo1 1Department of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, 200433, People’s Republic of China; 2Department of Anesthesiology, Yueyang Hospital of Integrated Traditional and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, People’s Republic of ChinaCorrespondence: Lulong Bo, Department of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, 200433, People’s Republic of China, Email bartbo@smmu.edu.cnAbstract: Peroral Endoscopic Myotomy (POEM) is a minimally invasive procedure for treating esophageal achalasia, but effective postoperative pain management remains a challenge. Pain following POEM is multifactorial, arising from mechanical, chemical, and thermal stimuli that activate nociceptive and neuropathic pain pathways. A multimodal analgesia approach, combining opioids, non-opioid analgesics, and regional anesthesia, is currently the most effective strategy. Opioids remain a cornerstone of pain management, but their side effects, such as nausea and constipation, highlight the need for alternatives. Non-opioid analgesics, including acetaminophen, COX-2 inhibitors, and magnesium, have shown promise in reducing pain and opioid use. Regional anesthesia techniques, such as thoracic paravertebral blocks and erector spinae plane blocks, have been explored, though their efficacy in POEM remains inconclusive. Despite advances, there are ongoing challenges in standardizing pain management protocols. Variability in clinical practices and limited high-quality research with small sample sizes complicate the development of universally applicable guidelines. Additionally, while current research primarily focuses on acute postoperative pain, long-term outcomes, such as chronic pain and quality of life, require further investigation. Addressing these gaps in knowledge will be key to improving pain management practices and optimizing recovery for POEM patients. Future studies should focus on refining multimodal analgesia strategies, exploring new analgesic agents, and evaluating long-term pain management outcomes to enhance patient care and improve clinical results.Keywords: multimodal analgesia, non-opioid analgesics, opioid analgesics, peroral endoscopic myotomy, postoperative pain management, regional anesthesia |
| format | Article |
| id | doaj-art-4e6f45d1aa3d453cbabb0ed01459a3d2 |
| institution | Matheson Library |
| issn | 1178-7090 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Journal of Pain Research |
| spelling | doaj-art-4e6f45d1aa3d453cbabb0ed01459a3d22025-06-25T21:33:47ZengDove Medical PressJournal of Pain Research1178-70902025-05-01Volume 18Issue 127612773103467Postoperative Pain Management Strategies Following Peroral Endoscopic Myotomy (POEM): A ReviewLu J0Ji W1Sang C2Wang Z3Bo L4Department of AnesthesiologyDepartment of AnesthesiologyDepartment of AnesthesiologyDepartment of AnesthesiologyDepartment of AnesthesiologyJun Lu,1 Wentao Ji,1 Chao Sang,2 Zhi Wang,1 Lulong Bo1 1Department of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, 200433, People’s Republic of China; 2Department of Anesthesiology, Yueyang Hospital of Integrated Traditional and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, People’s Republic of ChinaCorrespondence: Lulong Bo, Department of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, 200433, People’s Republic of China, Email bartbo@smmu.edu.cnAbstract: Peroral Endoscopic Myotomy (POEM) is a minimally invasive procedure for treating esophageal achalasia, but effective postoperative pain management remains a challenge. Pain following POEM is multifactorial, arising from mechanical, chemical, and thermal stimuli that activate nociceptive and neuropathic pain pathways. A multimodal analgesia approach, combining opioids, non-opioid analgesics, and regional anesthesia, is currently the most effective strategy. Opioids remain a cornerstone of pain management, but their side effects, such as nausea and constipation, highlight the need for alternatives. Non-opioid analgesics, including acetaminophen, COX-2 inhibitors, and magnesium, have shown promise in reducing pain and opioid use. Regional anesthesia techniques, such as thoracic paravertebral blocks and erector spinae plane blocks, have been explored, though their efficacy in POEM remains inconclusive. Despite advances, there are ongoing challenges in standardizing pain management protocols. Variability in clinical practices and limited high-quality research with small sample sizes complicate the development of universally applicable guidelines. Additionally, while current research primarily focuses on acute postoperative pain, long-term outcomes, such as chronic pain and quality of life, require further investigation. Addressing these gaps in knowledge will be key to improving pain management practices and optimizing recovery for POEM patients. Future studies should focus on refining multimodal analgesia strategies, exploring new analgesic agents, and evaluating long-term pain management outcomes to enhance patient care and improve clinical results.Keywords: multimodal analgesia, non-opioid analgesics, opioid analgesics, peroral endoscopic myotomy, postoperative pain management, regional anesthesiahttps://www.dovepress.com/postoperative-pain-management-strategies-following-peroral-endoscopic--peer-reviewed-fulltext-article-JPRmultimodal analgesianon-Opioid Analgesicsopioid analgesicsperoral endoscopic myotomypostoperative pain managementregional anesthesia |
| spellingShingle | Lu J Ji W Sang C Wang Z Bo L Postoperative Pain Management Strategies Following Peroral Endoscopic Myotomy (POEM): A Review Journal of Pain Research multimodal analgesia non-Opioid Analgesics opioid analgesics peroral endoscopic myotomy postoperative pain management regional anesthesia |
| title | Postoperative Pain Management Strategies Following Peroral Endoscopic Myotomy (POEM): A Review |
| title_full | Postoperative Pain Management Strategies Following Peroral Endoscopic Myotomy (POEM): A Review |
| title_fullStr | Postoperative Pain Management Strategies Following Peroral Endoscopic Myotomy (POEM): A Review |
| title_full_unstemmed | Postoperative Pain Management Strategies Following Peroral Endoscopic Myotomy (POEM): A Review |
| title_short | Postoperative Pain Management Strategies Following Peroral Endoscopic Myotomy (POEM): A Review |
| title_sort | postoperative pain management strategies following peroral endoscopic myotomy poem a review |
| topic | multimodal analgesia non-Opioid Analgesics opioid analgesics peroral endoscopic myotomy postoperative pain management regional anesthesia |
| url | https://www.dovepress.com/postoperative-pain-management-strategies-following-peroral-endoscopic--peer-reviewed-fulltext-article-JPR |
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