{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T16:51:13Z","timestamp":1792083073592,"version":"4.4.0"},"reference-count":17,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"vor","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J. exp. orthop."],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:label\/>\n                    <jats:p>Moderate post\u2010operative pain after orthopaedic surgery remains highly prevalent and frequently persists beyond hospital discharge, negatively impacting mobilisation, rehabilitation, patient satisfaction and risk of chronic post\u2010surgical pain. Despite established multimodal analgesic strategies, clinical pathways remain heterogeneous and insufficiently standardised. The objective was to develop a shared, reproducible, and implementable model for the management of moderate post\u2010operative pain in orthopaedic surgery, both during hospitalisation and at discharge, to support institutional protocol development. An adapted virtual Nominal Group Technique (vNGT) was used as a structured consensus methodology. Three regional expert panels were convened in Campania, Lombardia and Emilia Romagna. Before each meeting, panellists completed a structured pre\u2010meeting survey and received preparatory material. Each meeting followed pre\u2010defined vNGT stages: introduction and framing of the consensus questions, individual idea generation, structured round\u2010robin sharing, clarification and refinement of statements, completion of standardised decision tables and post\u2010meeting review\/acceptance of the synthesised framework. Survey responses and decision tables were analysed qualitatively and comparatively to identify convergent principles, setting\u2010specific operational variables, and reproducible components. A reproducible model emerged based on systematic pain assessment, defined analgesic targets, multimodal analgesia centred on scheduled non\u2010opioid therapy, integration of loco\u2010regional techniques, rational, rescue based opioid use, structured continuity of care at discharge. Setting specific declinations were defined for: (1) Day surgery and Arthroscopy, (2) major trauma surgery in the elderly, (3) lower limb arthroplasty surgery and (4) discharge management across all settings. This vNGT\u2010derived framework provides an implementable structure for institutional pain management protocols in orthopaedic surgery and represents a foundation for future outcome\u2010based validation studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level N\/A.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jeo2.70846","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T14:27:52Z","timestamp":1783952872000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Management of moderate pain after orthopaedic surgery: A multiregional expert consensus model for postoperative and discharge protocol development"],"prefix":"10.1002","volume":"13","author":[{"given":"Gabriele","family":"Finco","sequence":"first","affiliation":[{"name":"Department of Medical Sciences and Public Health University of Cagliari Cagliari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Balato","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology University of Naples \u201cFederico II\u201d Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Busatto","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology Santa Maria delle Croci Hospital Ravenna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaetano","family":"Caruso","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology, AOU Ferrara Arcispedale Sant'Anna University of Ferrara Ferrara Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Colosio","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology Casa di Cura Citt\u00e0 di Parma Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Coviello","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Reproductive and Odontostomatological Sciences University of Naples \u201cFederico II\u201d Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerio","family":"Daffara","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology Spedali Civili Brescia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pasquale De","family":"Negri","sequence":"additional","affiliation":[{"name":"Department of Anesthesia Intensive Care and Pain Medicine, AORN S.Anna &amp; S. Sebastiano Caserta Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Don\u00e0","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology, Sassuolo Hospital University of Modena and Reggio Emilia Sassuolo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Ferri","sequence":"additional","affiliation":[{"name":"Department of Anesthesia Intensive Care and Pain Medicine, Casa di Cura Citt\u00e0 di Parma Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olimpio","family":"Galasso","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology, AOU San Giovanni di Dio e Ruggi d'Aragona University of Salerno Fisciano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Gasbarro","sequence":"additional","affiliation":[{"name":"Department of Anesthesia Postoperative Intensive Care and Pain Medicine, IRCCS Rizzoli Orthopaedic Institute Argenta Ferrara Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico Alberto","family":"Grassi","sequence":"additional","affiliation":[{"name":"Department of Clinical, Surgical, Diagnostic and Pediatric Sciences University of Pavia Pavia Italy"},{"name":"Orthopedics and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation Pavia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Innamorato","sequence":"additional","affiliation":[{"name":"Department of Neuroscience AUSL Romagna, Pain Unit, Santa Maria Delle Croci Hospital Ravenna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattia","family":"Loppini","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology IRCCS Humanitas Research Hospital Rozzano Milano Italy"},{"name":"Department of Biomedical Sciences Humanitas University Pieve Emanuele Milano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Benedetta","family":"Mascia","sequence":"additional","affiliation":[{"name":"Department of Anesthesia Intensive Care and Pain Medicine, IRCCS Policlinico San Matteo Foundation Pavia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Maria","family":"Matina","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Intensive Care and Pain Medicine, AOU Ferrara Arcispedale Sant'Anna University of Ferrara Ferrara Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo Francesco","family":"Minoli","sequence":"additional","affiliation":[{"name":"UOC Week Surgery, ASST Gaetano Pini\u2010CTO Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Perna","sequence":"additional","affiliation":[{"name":"Department of Neuroscience AUSL Romagna, Pain Unit, Santa Maria Delle Croci Hospital Ravenna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Placella","sequence":"additional","affiliation":[{"name":"Universit\u00e0 Vita\u2010Salute San Raffaele Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Prisco","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, TIPO e OTI Antonio Cardarelli Hospital Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Ramponi","sequence":"additional","affiliation":[{"name":"1st Orthopaedic and Traumatologic Department IRCCS Istituto Ortopedico Rizzoli Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Sbalzer","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care Spedali Civili di Brescia Brescia 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