Management of moderate pain after orthopaedic surgery: A multiregional expert consensus model for postoperative and discharge protocol development

Finco G, Balato G, Busatto C, Caruso G, Colosio A, Coviello A, Daffara V, Negri P, Donà A, Ferri S, Galasso O, Gasbarro G, Grassi FA, Innamorato M, Loppini M, Mascia MB, Matina AM, Minoli CF, Perna P, Placella G, Prisco E, Ramponi L, Sbalzer N, Sangiovanni P, Sansone P, Tasso F, Tognù A, Toro G, Torsello G, Di Martino A. Management of moderate pain after orthopaedic surgery: A multiregional expert consensus model for postoperative and discharge protocol development. J Exp Orthop. 2026 Jul 13;13(3):e70846. doi: 10.1002/jeo2.70846. PMID: 42445815; PMCID: PMC13361057.

Abstract

Moderate post‐operative pain after orthopaedic surgery remains highly prevalent and frequently persists beyond hospital discharge, negatively impacting mobilisation, rehabilitation, patient satisfaction and risk of chronic post‐surgical pain. Despite established multimodal analgesic strategies, clinical pathways remain heterogeneous and insufficiently standardised. The objective was to develop a shared, reproducible, and implementable model for the management of moderate post‐operative pain in orthopaedic surgery, both during hospitalisation and at discharge, to support institutional protocol development. An adapted virtual Nominal Group Technique (vNGT) was used as a structured consensus methodology. Three regional expert panels were convened in Campania, Lombardia and Emilia Romagna. Before each meeting, panellists completed a structured pre‐meeting survey and received preparatory material. Each meeting followed pre‐defined vNGT stages: introduction and framing of the consensus questions, individual idea generation, structured round‐robin sharing, clarification and refinement of statements, completion of standardised decision tables and post‐meeting review/acceptance of the synthesised framework. Survey responses and decision tables were analysed qualitatively and comparatively to identify convergent principles, setting‐specific operational variables, and reproducible components. A reproducible model emerged based on systematic pain assessment, defined analgesic targets, multimodal analgesia centred on scheduled non‐opioid therapy, integration of loco‐regional techniques, rational, rescue based opioid use, structured continuity of care at discharge. Setting specific declinations were defined for: (1) Day surgery and Arthroscopy, (2) major trauma surgery in the elderly, (3) lower limb arthroplasty surgery and (4) discharge management across all settings. This vNGT‐derived framework provides an implementable structure for institutional pain management protocols in orthopaedic surgery and represents a foundation for future outcome‐based validation studies. Level of Evidence Level N/A.

Keywords: ibuprofen; multimodal analgesia; orthopaedic surgery; paracetamol; post‐operative pain.