ABSTRACT
Background:
Effective postoperative pain management is essential for enhancing recovery and improving patient outcomes. Multimodal analgesia (MMA) combines different analgesic approaches to optimize pain control while reducing opioid dependence. This study evaluates the effectiveness of MMA in managing postoperative pain across various surgical procedures.
Objectives:
To assess the impact of multimodal analgesia on postoperative pain relief, opioid consumption, and associated side effects.
Methods:
A quasi-experimental study was conducted with 60 patients divided into a study group (n=30) receiving MMA and a control group (n=30) receiving standard pain management. Pain levels were assessed using the Visual Analog Scale (VAS) at 6, 12, and 24 hours post-surgery. Opioid consumption and the incidence of side effects were also recorded.
Results:
The study group reported significantly lower VAS pain scores at all time points compared to the control group. Additionally, opioid consumption was reduced, with fewer opioid-related side effects observed in the MMA group.
Conclusion:
Multimodal analgesia effectively reduces postoperative pain, minimizes opioid use, and decreases associated side effects, supporting its broader implementation in clinical pain management strategies.
KEYWORDS: Enhanced recovery, multimodal analgesia, opioid-sparing, pain control, patient outcomes, postoperative pain management, visual analog scale
INTRODUCTION
Postoperative pain management remains a cornerstone of surgical recovery, directly influencing patient satisfaction, mobility, and overall outcomes. Despite advancements in analgesic techniques, many patients experience suboptimal pain relief, which can delay recovery and increase the risk of chronic pain syndromes.[1] Traditional reliance on opioids for postoperative pain control often leads to significant side effects, including nausea, sedation, respiratory depression, and the potential for dependency.[2] Multimodal analgesia (MMA) offers an alternative approach, combining different classes of analgesics and techniques to achieve effective pain relief while minimizing opioid use.[3] By targeting various pain pathways, MMA enhances pain control and reduces the adverse effects associated with high-dose opioids. Studies have shown that MMA improves recovery and reduces hospital stays, making it an essential component of modern pain management protocols.[4]
This study aims to evaluate the efficacy of MMA in managing postoperative pain compared to standard pain management practices. By examining pain scores, opioid consumption, and associated side effects, the study seeks to provide evidence supporting the integration of MMA into routine clinical practice.
MATERIALS AND METHODS
A quasi-experimental study was conducted to evaluate the effectiveness of multimodal MMA in postoperative pain management. The study involved 60 patients undergoing various surgical procedures at a tertiary care hospital. Patients were randomly assigned to either the study group (n = 30) or the control group (n = 30). The study group received MMA, consisting of a combination of non-opioid analgesics (paracetamol and NSAIDs), regional anesthesia techniques, and adjuncts such as gabapentinoids or ketamine. The control group received standard pain management with opioids as the primary analgesic. Pain levels were assessed using the VAS at 6, 12, and 24 h post-surgery. Opioid consumption and side effects such as nausea, sedation, and respiratory depression were also recorded.
Ethical approval was obtained from the institutional ethics committee, and informed consent was secured from all participants. Data were analyzed using paired and independent t-tests for pain scores and Chi-square tests for categorical variables. A P value of <0.05 was considered statistically significant.
RESULTS
The study demonstrated that MMA significantly improved postoperative pain management compared to standard opioid-based care. Pain scores, measured using the VAS, were markedly lower in the study group at 6, 12, and 24 h post-surgery (P < 0.001). The study group also showed a significant reduction in total opioid consumption (15.4 ± 4.2 mg vs. 28.7 ± 5.1 mg, P < 0.001) and a lower incidence of opioid-related side effects such as nausea (20% vs. 60%) and sedation (13% vs. 47%). These findings underscore the efficacy of MMA in enhancing postoperative recovery and minimizing opioid-related complications.
Demographic characteristics of the participants
Table 1 presents the demographic characteristics of the study participants. Both the study and control groups were comparable in terms of age, gender, type of surgery, and baseline pain levels, ensuring homogeneity between groups.
Table 1.
Demographic characteristics of participants
| Characteristic | Study Group (n=30) | Control Group (n=30) | Total (n=60) |
|---|---|---|---|
| Age (Mean±SD) | 42.3±10.5 | 41.8±9.8 | 42.05±10.15 |
| Gender (M/F) | 16/14 | 15/15 | 31/29 |
| Type of Surgery | Orthopedic: 10, Abdominal: 20 | Orthopedic: 9, Abdominal: 21 | Orthopedic: 19, Abdominal: 41 |
| Baseline VAS Score | 7.4±0.8 | 7.3±0.9 | 7.35±0.85 |
Pain scores post-intervention
Table 2 summarizes the VAS pain scores at 6, 12, and 24 h post-surgery. The study group showed significantly lower pain scores compared to the control group at all time points.
Table 2.
Comparison of VAS pain scores post-surgery
| Time Interval (Hours) | Study Group (Mean±SD) | Control Group (Mean±SD) | P |
|---|---|---|---|
| 6 Hours | 4.2±1.1 | 6.8±1.2 | <0.001 |
| 12 Hours | 3.6±0.9 | 5.9±1.1 | <0.001 |
| 24 Hours | 2.8±0.8 | 5.1±1.0 | <0.001 |
Opioid consumption
Table 3 highlights the total opioid consumption (in mg morphine equivalent) over 24 h post-surgery. The study group required significantly lower opioid doses compared to the control group.
Table 3.
Total opioid consumption (mg Morphine Equivalent)
| Group | Mean±SD | P |
|---|---|---|
| Study Group (n=30) | 15.4±4.2 | <0.001 |
| Control Group (n=30) | 28.7±5.1 | <0.001 |
Adverse effects
Table 4 compares the incidence of opioid-related side effects between the two groups. The study group reported fewer adverse effects, emphasizing the opioid-sparing benefits of MMA.
Table 4.
Incidence of opioid-related side effects
| Side Effect | Study Group (n=30) | Control Group (n=30) | P |
|---|---|---|---|
| Nausea (%) | 6 (20%) | 18 (60%) | <0.001 |
| Sedation (%) | 4 (13%) | 14 (47%) | <0.001 |
| Respiratory Depression (%) | 0 (0%) | 3 (10%) | 0.07 |
DISCUSSION
This study highlights the significant benefits of MMA in managing postoperative pain.[5] The findings demonstrate that MMA not only provides superior pain control compared to standard opioid-based therapy but also reduces opioid consumption and associated adverse effects. Lower pain scores at 6, 12, and 24 h post-surgery indicate the effectiveness of MMA in addressing acute postoperative pain, enhancing patient comfort, and facilitating early recovery.[6]
The opioid-sparing effect of MMA is particularly noteworthy, as it minimizes the risk of opioid-related side effects such as nausea, sedation, and respiratory depression. These results align with existing evidence supporting the use of MMA to improve surgical outcomes and patient satisfaction.[7] By targeting multiple pain pathways through a combination of pharmacological and regional techniques, MMA offers a comprehensive approach to pain management.[8]
However, the study has limitations, including a small sample size and the inclusion of only two types of surgeries. Future research with larger, more diverse populations is recommended to generalize these findings and explore the long-term benefits of MMA on recovery and rehabilitation.
CONCLUSION
MMA is a highly effective approach for postoperative pain management, significantly reducing pain scores, opioid consumption, and associated side effects. By integrating various pharmacological and regional techniques, MMA offers superior pain control compared to standard opioid-based therapies. This study underscores the potential of MMA to enhance recovery and improve patient outcomes, making it a valuable addition to postoperative care protocols. Further research is warranted to confirm these findings across diverse surgical procedures and patient populations.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
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