The Intraoperative Adherence to Multimodal Analgesia of Anesthesiologists: A Retrospective Study

Abstract

Introduction: Multimodal analgesia (MMA) is a critical component of enhanced recovery after surgery (ERAS). However, little research revealed its intraoperative implementation by anesthesiologists, who are on the front line defending against surgical pain. Therefore, the objective of our study is to assess the adherence of anesthesiologists to MMA comprehensively. Methods: A retrospective study was conducted involving patients undergoing lung resection, knee arthroplasty, and radical mastectomy from pre/post-implementation year of MMA (Jan 1, 2013, to Dec 31, 2013, vs. 2019. Intraoperative analgesia regimens (analgesic mode) and hourly rated morphine milligram equivalents (MME) were compared. In addition, patient characteristics associated with continued opioid use after surgery, surgical types, and position level of anesthesiologists (attending-junior; above attending-senior) were also analyzed. Results: After MMA initiation, the rate of multimodal analgesic regimen (mode C 2) was significantly increased (post-vs. pre-implementation, 31.57 vs. 21.50%, p \ 0.05). However, MME did not show significant difference (post-vs. pre-implementation, 0.402 vs. 0.456, p [ 0.05). Patient-level predictors of persistent opioid use after surgery were not related to increased analgesic mode. Lung resection [coefficient, -0.538; 95% confidence interval (CI), -0.695 to -0.383, p \ 0.001] and knee arthroplasty (coefficient, -1.143; 95% CI, -1.366 to -0.925, p \ 0.001) discouraged multiple analgesic mode, while senior anesthesiologists (coefficient, 0.674; 95% CI 0.548-0.800, p \ 0.001) promoted it. Conclusions: Although anesthesiologists used more analgesics after promoting MMA, the ''opioid-sparing'' principle was not followed properly. The analgesic mode was not instructed by patients' characteristics appropriately. In addition, surgeries with cumbersome preparation/process impeded the use of multiple Y. He Á G. Tan (&) Á Y. Huang (&)

[Retracted] Analysis of Interventional Application Effect of Ultrasound‐Guided QLB and TAPB in the Treatment and Analgesia of Patients Undergoing Laparoscopic Colorectal Surgery

“…Surgical treatment is mainly used in clinic at the present stage [ 9 , 10 ]. In order to relieve the pain of patients during and after surgery, general anesthesia combined with QLB block or TAPB block is performed during and after surgery, which has a significant effect on relieving the pain of patients [ 11 , 12 ]. The mechanism of TAPB is to inject local anesthetic into the nerve fascia layer between the internal oblique muscle and transverse abdominis muscle to block relevant nerve sensory conduction so as to weaken the pain sensation in the skin, muscle, and parietal peritoneum of the anterior abdomen and achieve good abdominal analgesia [ 13 , 14 ].…”

Developing expert international consensus statements for opioid-sparing analgesia using the Delphi method

“…For the first two rounds, the panellists were presented with eight statements based on our initial research on multimodal analgesia, seeking their perspectives on the strength of evidence as well as potential obstacles to adoption in the post-operative setting [13][14][15]. They could indicate their level of agreement on a fivepoint Likert scale.…”

Multimodal Anesthesia as an Important Component of Eras

“…Хоча після початку ММА інтраопераційно застосовувалося більше режимів знеболювання, відмінностей у споживанні опіоїдів не спостерігалося, що вказує на погану відданість ММА з боку анестезіологів. Більше того, пацієнти з ризиком постійного вживання опіоїдів після операції не були виявлені і не було призначено належне знеболювальне рішення [24].…”