Pain Management Strategies After Abdominal Surgery: A Systematic Review of Anesthetic and Analgesic Interventions

Abstract

Background: Effective perioperative pain management is important for recovery after abdominal surgery, reducing morbidity and improving patient outcomes. Thoracic epidural analgesia (TEA) has long been considered the gold standard. Newer regional anaesthesia and multimodal analgesic approaches are increasingly used to improve efficacy and safety. Method: This systematic review evaluated randomized controlled trials and clinical studies published between 2013 to 2025 focusing on anesthetic and analgesic strategies for postoperative pain in adult patients undergoing abdominal surgery. Data regarding study design, patient population, interventions, and primary outcomes, including pain scores, opioid consumption, and recovery parameters, were synthesized. Result: Eleven eligible studies were identified. Evidence suggests that fascial plane blocks, transversus abdominis plane block, erector spinae plane block, and rectus sheath block provide comparable analgesia to TEA in selected populations, with fewer side effects. Adjunctive multimodal regimens, including intravenous agents, enhanced recovery pathways, and modified block techniques, showed further benefits in reducing opioid requirements and improving patient satisfaction. Conclusion: Fascial plane blocks and rectus sheath catheter analgesia, offer effective and safe alternatives to thoracic epidural analgesia for postoperative pain after abdominal surgery. When combined with multimodal regimens, these strategies reduce opioid consumption, improve recovery, and patient satisfaction. Individualized, block-based, and multimodal approaches should be considered to optimize perioperative pain management in abdominal surgery.