Overview of multimodal analgesia initiated in the perioperative setting

Tubog, Tito D

doi:10.1177/1750458920928843

Cited by 8 publications

(13 citation statements)

References 40 publications

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“…The impact of MMA in reducing opioid consumption, decreasing adverse effects, and improving postoperative recovery is well documented in the literature [1,9,16]. A variety of MMA protocols with or without the addition of regional anesthesia techniques have been studied.…”

Section: Discussionmentioning

confidence: 99%

“…Preoperative anxiety, catastrophizing and decreased response to conditioned pain modulation have been identified as risk factors for patients likely to experience persistent, uncontrolled postoperative pain. Patients receiving preoperative education have less anxiety, lower pain scores, reduced hospital LOS, and a faster return to their baseline [9,19]. Thus, it is recommended that patients receive preoperative counseling to help establish appropriate expectations for postoperative pain and proper management [9,19,26,32].…”

Section: Next Stepsmentioning

confidence: 99%

“…Multimodal analgesia employs a combination of analgesics (e.g., acetaminophen (APAP), gabapentinoids, ketamine, lidocaine, and non-steroidal anti-inflammatory drugs) and/or therapeutic techniques (e.g., regional anesthesia) to target different sensory pathways in the central and peripheral nervous system concomitantly, thereby minimizing postoperative opioid utilization and subsequent complications [5,[7][8][9]. Studies have also demonstrated that a reduction in opioid consumption correlates with an increase in mobility, a decrease in fatigue, and an overall decrease in symptom burden for patients in multiple surgical settings [1,10].…”

Section: Introductionmentioning

confidence: 99%

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The impact of a postoperative multimodal analgesia pathway on opioid use and outcomes after cardiothoracic surgery

Ward

Moll

Boorman

et al. 2022

J Cardiothorac Surg

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Objective The Enhanced Recovery after Surgery Cardiac Society recommends using multimodal analgesia (MMA) for postoperative pain however, evidence-based guidelines have yet to be established. This study examines the impact of a standardized postoperative MMA pathway in reducing opioid consumption and related complications after cardiothoracic surgery (CTS). Methods Within a multicenter healthcare system, a postoperative MMA pathway was developed and implemented at two CTS intensive care units (ICU) while the other CTS ICU opted to maintain the existing opioid-based pathway. A retrospective chart review was conducted on patients admitted to a CTS ICU within this healthcare system after conventional coronary artery bypass grafting and/or valve surgery from September 1, 2018, to June 30, 2019. Comparative analysis was conducted on patients prescribed MMA versus those managed with an opioid-based pathway. The primary outcome was total opioid consumption, converted to morphine milligram equivalents, 72-h post-surgery. Secondary outcomes included mobility within one-day post-surgery, ICU length of stay (LOS), time to first bowel movement (BM), and time to first zero Richmond Agitation-Sedation Scale (RASS). Results Seven hundred sixty-two adults were included for final analysis. The MMA group had a higher body mass index, higher percentage of females, were more likely classified as African American and had higher scores for risk-adjusted complications. General Linear Model analysis revealed higher opioid consumption in the MMA group (Est. 0.22, p < 0.0009); however, this was not statistically significant after adjusting for differences in fentanyl usage. The MMA group was more likely to have mobility within one-day post-surgery (OR 0.44, p < 0.0001), have longer time to first BM (OR 1.93, p = 0.0011), and longer time to first zero RASS (OR 1.62, p = 0.0071). The analgesia groups were not a predictor for ICU LOS. Conclusions Opioid consumption was not reduced secondary to this postoperative MMA pathway. The MMA group was more likely to have mobility within one-day post-surgery. Patients in the MMA group were also more likely to have prolonged time to first BM and first zero RASS. Development and evaluation of a perioperative MMA pathway should be considered.

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Section: Discussionmentioning

confidence: 99%

Section: Next Stepsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The impact of a postoperative multimodal analgesia pathway on opioid use and outcomes after cardiothoracic surgery

Ward

Moll

Boorman

et al. 2022

J Cardiothorac Surg

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“…In addition to EA, abortive medications, intravenous medications, peripheral nerve blocks, and other methods of postoperative pain management are widely used. Multi-model analgesia, which compensates for the shortcomings of each analgesic method rather than providing pain management in isolation, is essential (Tubog 2021). Previous studies have reported that postoperative analgesia with EA for RRP prolongs the length of hospital stay (Mir et al 2013).…”

Section: Accepted Manuscript 14mentioning

confidence: 99%

Effect of Postoperative Pain Management after Robot-Assisted Radical Prostatectomy: A Study on Reducing Hospital Length of Stay and Medical Costs Using Japanese Nationwide Database

Mizuta

Tarasawa

Fushimi

et al. 2023

Tohoku J. Exp. Med.

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Prostate cancer has a high incidence rate. Many articles reported its usefulness with the advent of robotic surgery in 2001. However, epidural analgesia is declining due to the spread of minimally invasive treatment. There have been no studies using nationwide databases on the impact of epidural analgesia use on length of hospital stay and medical costs. Therefore, we used a Japanese national inpatient database from April 2016 to March 2020. The study population included 46,166 patients. We compared a postoperative analgesia management group using epidural analgesia (EA Group: 5,354) and a group not using epidural analgesia (non-EA Group: 40,812). We found significant differences among the two groups regarding the length of stay, Days from Surgery to Discharge, and Inpatient cost of surgery to discharge. Hospital length of stay and postoperative hospital stay was statistically shorter in the EA group than in the non-EA group (11.3 ±2.8 days vs. 12.1 ± 3.1 days, p-value <0.001 and 8.9 ±2.5days vs. 9.3 ±2.7days, p-value <0.001) respectively, and medical costs were also significantly lower in the EA group (￥284,566 vs. ￥294,277, p-value <0.001). Also, the ADL assessment at discharge determined a considerably higher score in the EA group than in the non-EA groups. Epidural analgesia for postoperative pain management largely depends on each medical institution's treatment A c c e p t e d M a n u s c r i p t 4 policy. However, epidural analgesia is declining due to the spread of minimally invasive treatment. Therefore, epidural analgesia should be reconsidered because it can reduce hospital stays and hospitalization costs.

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“…Hal tersebut dapat mengurangi dosis obat yang diberikan, termasuk dosis opioid dan dapat mengurangi efek samping yang muncul. 7 Dokumentasi pada manajemen nyeri pascaoperasi juga merupakan salah satu langkah penting dalam pelayanan manajemen nyeri. Rekam medis tersebut memberikan informasi penting bagi tim tenaga kesehatan untuk memberikan manajemen nyeri.…”

Section: Pendahuluanunclassified

Efektivitas dan Efisiensi Pencatatan efek Opioid pada Pasien Pascaoperasi di RSUP Dr. Sardjito, Indonesia

Mahmud

Rahardjo

Mahendra

et al. 2020

jap

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Nyeri merupakan pengalaman sensoris dan emosional yang tidak menyenangkan terkait dengan kerusakan jaringan aktual atau potensial. Nyeri dapat terjadi saat preoperasi, durante, dan pascaoperasi. Pada umumnya, manajemen nyeri intra dan pascaoperasi menggunakan opioid. Penelitian ini bertujuan menilai efektivitas dan efisiensi pencatatan evaluasi penggunaan opioid intraoperatif dan pascaoperasi dan dilaksanakan pada Maret-Oktober 2019 di RSUP Dr. Sarjito Yogyakarta. Penelitian ini menggunakan desain kohort retrospektif untuk melihat efektivitas dan efisiensi pemberian opioid intraoperatif terhadap efek analgesia pascaoperasi dengan mengukur skala NRS, prevalensi kejadian efek samping opioid post-operative nausea and vomiting (PONV), recovery room length of stay (LOS), serta penggunaan obat analgetik pascaoperasi. Pencatatan rekam medis yang kurang lengkap sehingga tidak dapat menilai efektivitas penggunaan opioid intraoperatif yang baik. Penggunaan opioid pascaoperasi memiliki hubungan yang bermakna dengan skor NRS 12 jam pascaoperasi dan kejadian komplikasi (p=0,025;p=0,028). Penggunaan opioid intraoperatif maupun pascaoperasi terhadap skor NRS, kejadian komplikasi, maupun lamanya waktu rawat di recovery room tidak terdapat hubungan yang bermakna. Simpulan, pencatatan evaluasi penggunaan opioid intraoperatif dan pascaoperasi di rekam medis masih belum lengkap. Penggunaan opioid intraoperatif tidak bermakna dalam menurunkan skor NRS, menurunkan kejadian komplikasi pascaoperasi, memperpendek lama rawat di recovery room, namun apabila opioid dilanjutkan pemberian pascabedah menurunkan NRS, tetapi efek samping opioid lebih tinggi.

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Overview of multimodal analgesia initiated in the perioperative setting

Cited by 8 publications

References 40 publications

The impact of a postoperative multimodal analgesia pathway on opioid use and outcomes after cardiothoracic surgery

The impact of a postoperative multimodal analgesia pathway on opioid use and outcomes after cardiothoracic surgery

Effect of Postoperative Pain Management after Robot-Assisted Radical Prostatectomy: A Study on Reducing Hospital Length of Stay and Medical Costs Using Japanese Nationwide Database

Efektivitas dan Efisiensi Pencatatan efek Opioid pada Pasien Pascaoperasi di RSUP Dr. Sardjito, Indonesia

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