Multimodal pain management should always be considered to improve analgesia while reducing individual class-related side effects; a pharmacological stepup approach including major opiates when necessary should be adopted. (1B)

Whenever contraindications are absent, acetaminophen, NSAIDs (1A), and gabapentinoids administration (2B) are recommended in multimodal analgesia.

Acetaminophen administered at the beginning of postoperative analgesia may be better and safer than other drugs. (1B)

Acetaminophen used in multimodal and preemptive therapy is associated with a reduction of opiates side effects and improved postoperative outcomes. (1B)

Coxib administration may be considered if there are no contraindications. (1B)

In the treatment of moderate-to-severe pain, unresponsive to other medications and in which regional anesthesia techniques are not indicated, the use of major opiate is indicated. (1B)

Initial infusion of opioids using intravenous patientcontrolled analgesia should be avoided in opioid naïve patients. (1B)

Sedation levels, respiratory status, and the possible development of adverse events in patients on systemic treatment with opioids must be regularly assessed. (1C)

If indicated, infusion of opiates using intravenous patient-controlled analgesia should be preferred to spinal patient-controlled analgesia in postoperative pain management whenever the intravenous route is viable. (1B)

Oral administration of analgesic drugs should be preferred over intravenous route whenever feasible, and drugs absorption may be reasonably warranted. (1B)