Effects of school-based nutrition literacy Intervention on obesity prevention in school-age students: a systematic review and meta-analysis.

In the modern era of surgical care, routine use of multimodal analgesia has become a foundational principle of acute perioperative pain management []. Within the United States, the administration of multimodal analgesia for eligible surgical cases is a national quality measure [], one of very few quality measures that directly relate to anesthesiologists. Implementation of multimodal analgesia has been associated with decreases in perioperative opioid use and complications after major surgery []. Given the data available at the time, we asserted in a 2018 review that designing an ideal perioperative pain management strategy should always start with multimodal analgesia [], and we believe that this still holds true today in spite of the many advances in surgery, anesthesiology, and perioperative medicine in recent years. At a minimum, multimodal analgesia is defined as the use of two or more analgesic therapies with different mechanisms of action with the goal of providing effective pain control [], while avoiding the overreliance on opioids and associated opioid-related adverse effects. These modalities may be nonpharmacologic, pharmacologic, or interventional, with interventional techniques varying in their invasiveness and duration of action. When used optimally in combination, the elements of a multimodal analgesic regimen target different and discrete points along the pain pathway and may be adjusted to treat patients with specific pain subtypes [,]. In our initial review of multimodal analgesia, we addressed the core pharmacologic and interventional elements, which included the following nonopioid systemic analgesics: acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclo-oxygenase-2 (COX-2) inhibitors, gabapentinoids, ketamine, magnesium, local anesthetics via surgical infiltration or peripheral nerve blocks, and lidocaine infusions. We also discussed appropriate indications and the judicious use of opioids []. However, healthcare worldwide continues to evolve, and there have been significant developments that have prompted this updated review of multimodal analgesia. In this paper, we provide an overview of important trends that influence the current approaches to acute perioperative pain management and an updated clinical guide on multimodal analgesia with an emphasis on new therapies.