Postoperative Pain Management Strategies Following Peroral Endoscopic Myotomy (POEM): A Review.

Abstract

Peroral Endoscopic Myotomy (POEM) is a minimally invasive procedure for treating esophageal achalasia, but effective postoperative pain management remains a challenge. Pain following POEM is multifactorial, arising from mechanical, chemical, and thermal stimuli that activate nociceptive and neuropathic pain pathways. A multimodal analgesia approach, combining opioids, non-opioid analgesics, and regional anesthesia, is currently the most effective strategy. Opioids remain a cornerstone of pain management, but their side effects, such as nausea and constipation, highlight the need for alternatives. Non-opioid analgesics, including acetaminophen, COX-2 inhibitors, and magnesium, have shown promise in reducing pain and opioid use. Regional anesthesia techniques, such as thoracic paravertebral blocks and erector spinae plane blocks, have been explored, though their efficacy in POEM remains inconclusive. Despite advances, there are ongoing challenges in standardizing pain management protocols. Variability in clinical practices and limited high-quality research with small sample sizes complicate the development of universally applicable guidelines. Additionally, while current research primarily focuses on acute postoperative pain, long-term outcomes, such as chronic pain and quality of life, require further investigation. Addressing these gaps in knowledge will be key to improving pain management practices and optimizing recovery for POEM patients. Future studies should focus on refining multimodal analgesia strategies, exploring new analgesic agents, and evaluating long-term pain management outcomes to enhance patient care and improve clinical results.