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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.<\/jats:p>","DOI":"10.1136\/tsaco-2026-002273","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T12:00:16Z","timestamp":1777550416000},"page":"e002273","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Regional, multimodal, and opioid-sparing strategies after trauma: a review"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-1274-5084","authenticated-orcid":false,"given":"Emily","family":"Hancin","sequence":"first","affiliation":[{"name":"Surgery, Cooper University Health Care, Camden, New Jersey, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6935-6572","authenticated-orcid":false,"given":"Purvi Pravinchandra","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Surgery, Loyola University Chicago, Maywood, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7386-2926","authenticated-orcid":false,"given":"Tanya","family":"Egodage","sequence":"additional","affiliation":[{"name":"Surgery, Cooper University Health Care, Camden, New Jersey, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"2026043005001355000_11.Suppl_1.e002273.1","doi-asserted-by":"crossref","DOI":"10.1097\/OI9.0000000000000376","article-title":"Trauma systems: a global comparison","volume":"8","author":"Miclau","year":"2025","journal-title":"OTA Int"},{"key":"2026043005001355000_11.Suppl_1.e002273.2","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.2007.61"},{"key":"2026043005001355000_11.Suppl_1.e002273.3","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2018.7673","article-title":"Association of Wearable Activity Monitors With Assessment of Daily Ambulation and Length of Stay Among Patients Undergoing Major Surgery","volume":"2","author":"Daskivich","year":"2019","journal-title":"JAMA Netw Open"},{"key":"2026043005001355000_11.Suppl_1.e002273.4","doi-asserted-by":"crossref","first-page":"1306","DOI":"10.1053\/j.jvca.2024.12.004","article-title":"Practice Advisory for Postoperative Pain Management of Thoracic Surgical Patients: A Report from the Society of Cardiovascular Anesthesiologists","volume":"39","author":"Makkad","year":"2025","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"2026043005001355000_11.Suppl_1.e002273.5","doi-asserted-by":"crossref","first-page":"1558","DOI":"10.1016\/S0140-6736(19)30430-1","article-title":"Perioperative opioid analgesia\u2014when is enough too much? 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