What is your approach to medication selection and titration for post-operative pain?

My general approach to postoperative pain management is a stepwise multimodal strategy that prioritizes opioid-sparing therapy while tailoring medication choices to patient-specific and surgical factors. In practice, I try to balance three things: the expected pain mechanism related to the surgery, the patient’s comorbidities and physiologic reserve, and the risk of medication-related adverse effects.

For most patients, I start with scheduled non-opioid analgesia as the backbone of therapy. Typically, this includes scheduled acetaminophen (for example, 975 mg every 6 hours), and if there are no contraindications such as renal dysfunction, bleeding risk, or surgical concerns, I will add an NSAID such as celecoxib 200 mg twice daily for its o...