Modern approaches to perioperative pain management and protecting against surgical stress in major abdominal surgeries: a narrative review

INTRODUCTION: Inadequate anaesthetic protection during surgery as well as poor control of postoperative pain are the trigger mechanisms of the surgical stress response, which represents a complex of homeostatic changes that significantly contribute to the development of postoperative complications. OBJECTIVE: The primary objective of this study was to summarize the current data on modern approaches to perioperative analgesia and protection of patients from surgical stress response during major abdominal surgeries. MATERIALS AND METHODS: The review includes sources which meet the objectives of the study and are indexed in the databases of PubMed, Google Scholar, MEDLINE, and eLibrary (for Russian authors). RESULTS: The analysis of the literature clearly identified the risk factors for the development of acute postoperative pain and demonstrated a trend towards combining postoperative analgesic methods. These approaches reduce the need for opioids, effectively modulate in the perioperative period stress response to surgical intervention, and decrease the risk of postoperative complications in abdominal surgery. CONCLUSIONS: Modern approaches to perioperative analgesia when used in a timely and appropriate manner are largely responsible for ensuring adequate patient protection. The trend towards decreasing opioid use during perioperative period suggests the combination of various techniques. Epidural analgesia (EA), erector spinae plane (ESP), quadratus lumborum (QLB), or transversus abdominis plane (TAP) blocks, intravenous lidocaine infusion, and nefopam are effective and complementary components of multimodal perioperative pain management. © 2025 Elsevier B.V., All rights reserved.