IMPACT OF MULTIMODAL ANALGESIA IN THE PREVENTION OF OPIOID-INDUCED HYPERALGESIA IN THE IMMEDIATE POSTOPERATIVE PERIOD

Abstract

Opioid-induced hyperalgesia (OIH) in the immediate postoperative period represents a challenging clinical paradox, characterized by an increased sensitivity to pain resulting from the use of potent opioid agonists during surgery. The main objective of this study was to analyze the impact of multimodal analgesia on preventing OIH during the immediate postoperative period. An integrative literature review was conducted through structured searches in PubMed, SciELO, LILACS, and Cochrane CENTRAL databases, selecting 26 articles published between 2020 and 2026. The results indicate that intraoperative infusion of ultra-short-acting opioids, notably remifentanil, acts as the primary trigger for central sensitization, mediated by NMDA receptor hyperactivation and glial neuroinflammatory cascades. The application of multimodal analgesia protocols—based on the synergistic combination of NMDA antagonists (ketamine), alpha-2 adrenergic agonists (dexmedetomidine), gabapentinoids, and regional anesthesia techniques—was found to exert a robust protective role. These interventions substantially decrease the cumulative consumption of rescue opioids, lower pain scores, and mitigate mechanical allodynia in the post-anesthesia care unit. It is concluded that the multimodal approach is indispensable to prevent OIH, reduce postoperative complications, and accelerate hospital discharge, establishing itself as the perioperative gold standard.