Regional, multimodal, and opioid-sparing strategies after trauma: a review

Effective analgesia is fundamental in the management of trauma, critical care, and emergency surgical patients. However, historical reliance on opioid-based pain management strategies can be associated with adverse effects, including respiratory depression, delirium, and prolonged opioid exposure after discharge, leading to dependence. In response, multimodal analgesia strategies emphasizing non-opioid and regional techniques have become an important adjunct in trauma care pathways. This review summarizes current evidence supporting neuraxial anesthesia, peripheral and truncal nerve blocks, and non-opioid pharmacological agents as components of opioid-sparing analgesic techniques in injured and critically ill patients. Collectively, these pain management strategies support an evidence-based approach to analgesia that reduces opioid exposure and optimizes early walking and functional recovery in postoperative patients. Integration of these modalities into protocolized and perioperative pathways represents a critical step toward more effective analgesia for patients.