Effective analgesia is fundamental in the management of trauma, critical care, and emergency surgical patients. 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.

A 69-year-old woman with a recurrent skull-base meningioma developed recurrent hypothermia during rehabilitation, initially misattributed to infection. Episodes followed a circadian pattern and were associated with delirium, pancytopenia, and signs of central endocrine dysfunction. MRI showed a large meningioma compressing the hypothalamus with an intact corpus callosum. Infection and adrenal insufficiency were excluded. Hypothermia resolved with external warming, and pancytopenia normalized spontaneously. Subclinical hypothyroidism and central hypogonadism were noted, consistent with hypothalamic-pituitary axis involvement. These findings supported a diagnosis of acquired spontaneous periodic hypothermia (SPH) due to hypothalamic compression. This case illustrates that early recognition of SPH in patients with skull-base tumors can prevent misdiagnosis and guide appropriate supportive care and monitoring.

Postoperative sleep disturbance (PSD) is a common complication following laparoscopic cholecystectomy (LC). It is associated with delirium, cognitive decline and delayed recovery. Effective preventive strategies are currently lacking. Dexmedetomidine, a highly selective α₂-adrenergic receptor agonist, offered in a nasal spray formulation with high bioavailability and convenient administration, may present a novel approach for PSD prevention.