Multimodal Analgesia for the Management of Postoperative Pain

Bujedo, Borja Mugabure; Santos, S. González; UríaAzpiazu, Amaia; Noriega, Anxo Rubín; Salazar, David García; Andueza, ManuelAzkona

doi:10.5772/57401

Cited by 8 publications

(5 citation statements)

References 105 publications

(109 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We examined four surgeries, selected because they span across four different surgical specialties and there is an evidence base for the benefits of multimodal analgesia with these procedures 44 . However, even amongst these procedures, we observed differences in the use of multimodal therapy by surgery type.…”

Section: Discussionmentioning

confidence: 99%

Variations in the Use of Perioperative Multimodal Analgesic Therapy

et al. 2016

View full text Add to dashboard Cite

Background Practice guidelines for perioperative pain management recommend that multimodal analgesic therapy should be used for all postsurgical patients. However, the proportion of patients who actually receive this evidence-based approach is unknown. The objective of this study was to describe hospital-level patterns in the utilization of perioperative multimodal analgesia. Methods Data for the study were obtained from the Premier Research Database. Patients undergoing below-knee amputation, open lobectomy, total knee arthroplasty, and open colectomy between 2007 and 2014 were included in the analysis. Patients were considered to have multimodal therapy if they received one or more nonopioid analgesic therapies. Mixed-effects logistic regression models were used to estimate the hospital-specific frequency of multimodal therapy use while adjusting for the case mix of patients and hospital characteristics and accounting for random variation. Results The cohort consisted of 799,449 patients who underwent a procedure at 1 of 315 hospitals. The mean probability of receiving multimodal therapy was 90.4%, with 95% of the hospitals having a predicted probability between 42.6 and 99.2%. A secondary analysis examined whether patients received two or more nonopioid analgesics, which gave an average predicted probability of 54.2%, with 95% of the hospitals having a predicted probability between 9.3 and 93.2%. Conclusions In this large nationwide sample of surgical admissions in the United States, the authors observed tremendous variation in the utilization of multimodal therapy not accounted for by patient or hospital characteristics. Efforts should be made to identify why there are variations in the use of multimodal analgesic therapy and to promote its adoption in appropriate patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Variations in the Use of Perioperative Multimodal Analgesic Therapy

et al. 2016

View full text Add to dashboard Cite

show abstract

“…During the last decades, we have witnessed significant advances in our understanding of the pathophysiologic basis in acute pain thus appreciating the multidimensional and multifaceted nature of pain [73]. This emerging evidence paved the way to a multidisciplinary treatment approach for pain management that entails medical, physical and psychological therapies among which the multimodal analgesic regimens stand as promising treatment options [10,11]. Thus, clinical use of combinations of analgesic drugs has augmented considerably in the last decades with the aim of achieving greater analgesic efficacy (by targeting multiple modes and sites of action) along with fewer untoward effects, commonly observed due to efficacy and/ or safety concerns.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, clinical use of combinations of analgesic drugs has augmented considerably in the last decades with the aim of achieving greater analgesic efficacy (by targeting multiple modes and sites of action) along with fewer untoward effects, commonly observed due to efficacy and/ or safety concerns. A mounting evidence suggests that the synergy created when multimodal regimens are used to target discrete components of the peripheral and central pain pathways provides effective analgesia at lower opioid dosing, reducing related risk and producing fewer adverse effects [10,11,[58][59][60]. Accordingly, international guidelines advocate a multimodal approach for pain management by identifying NSAIDs as an integral part of this treatment approach [33,35,74].…”

Section: Discussionmentioning

confidence: 99%

“…Multimodal approach with its opioid-sparing effects achieves similar control of pain with fewer opioids (viz. opioid alone), along with a lower incidence of opioidrelated side effects such as nausea, vomiting, sedation, and pruritus [11,43,44]. NSAIDs are not alike in terms of opioid-sparing effect.…”

Section: Nsaids: Opioid-sparing Pillars Of a Multimodal Therapy For Painmentioning

confidence: 99%

“…Owing to pain's complex pathophysiology and to its multidimensional nature, a multidisciplinary approach is essential to successfully manage both outpatient and inpatient settings. Pain management in today's practice has progressed to embrace a wide variety of multi-level interventions including medical, physical and psychological therapies, among which multimodal analgesia stands as a promising component [10,11]. Therefore, it is of outmost importance to reconcile the burden of pain under-treatment with the mounting evidence supporting the efficacy of multimodal analgesia in a wide range of painful conditions.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Expanding Role of the COX Inhibitor/Opioid Receptor Agonist Combination in the Management of Pain

Varrassi¹,

Yeam

Rekatsina

et al. 2020

Drugs

View full text Add to dashboard Cite

Pain management in both outpatient and inpatient settings demands a multidisciplinary approach entailing medical, physical and psychological therapies. Among these, multimodal analgesic regimens stand out as a promising treatment options. Cyclo-oxygenase (COX) inhibitor/opioid receptor agonist combinations hold great potential as effective pillars in the multimodal pain management by providing adequate analgesia with fewer safety risks due to COX inhibitors’ opioid-sparing effect. Thus, these combinations, either freely or in fixed-dose formulation, offer a feasible option for the prescribing clinicians who seek to maximise therapeutic effect while simultaneously minimise adverse effects. The selection of the appropriate non-steroidal anti-inflammatory drug (NSAID) and opioid agent at optimal doses is essential. It should be tailored to the patients’ analgesic necessities, and his/her gastrointestinal and cardiovascular risk, and potential concurrent aspirin use. Moreover, it should allow for addiction risk and the potential opioid-induced bowel dysfunction and constipation. To ensure an optimal match between the characteristics of the patient and the properties of the chosen medication, and to guide adequate and well-tolerated treatment decisions, it is of paramount importance to expand clinicians’ knowledge of the currently available COX inhibitor/opioid receptor agonist combinations. This invited narrative review deals with the literature evidence covering the components of multimodal opioid-sparing analgesic regimens. Also, it provides insights into the clinically relevant choice criteria to ensure a patient-tailored analgesia.

show abstract