Comparison of Postoperative Analgesic Efficacy of Multimodal Analgesia Versus Opioid-Based Regimens in General Surgery Patients.

Abstract

Background: A successful postoperative pain management is the key to an ideal recovery after surgery. Although the analgesia based on opioids has been the conventional method, it is limited by undesirable side effects and deprivation, among others. Conversely, multimodal analgesia involving a multimodal approach, where several pharmacological agents are used together, is a promising pain management approach with reduced rates of opioid consumption. The proposed study paper attempts to compare the effectiveness of multimodal analgesia to opioid-based regimens within general surgery patients.

Objectives: to compare the postoperative analgesic effect of multimodal analgesia against Opioid-based regimens on general surgery patients with specific reference to pain relief, opioid use, side effects, and post-surgery recovery.

Methodology: this prospective observational study done on 100 general surgical patients who underwent elective operations. A randomized assignment of patients to multimodal analgesia (comprising NSAIDs, acetaminophen, local anesthetics, and gabapentin) or opioid-based analgesia (including morphine or fentanyl) was used. The measurements of pain were done through the visual analog scale (VAS) during rest and during movement. The use of opioids was monitored, and any side effects like nausea, sedation, and constipation were noted. The measures used to measure functional recovery included admission time, length of hospitalization, and postoperative complications. The comparison between the two groups was done through statistical tests, which were t-tests and chi-square tests (p < 0.05).

Results:The multimodal analgesia group (n=50) had significantly lower pain scores at rest (VAS: 2.5 ± 1.3 vs. 4.1 ± 1.8, p < 0.01) and during movement (VAS: 3.1 ± 1.5 vs. 5.3 ± 2.2, p < 0.01) compared to the opioid group. Opioid consumption was reduced by 40% in the multimodal group (30 mg morphine equivalents vs. 50 mg, p < 0.05). The multimodal group also experienced fewer side effects, including nausea (10% vs. 24%, p < 0.05), sedation (8% vs. 22%, p < 0.05), and constipation (6% vs. 18%, p < 0.05). Furthermore, functional recovery was faster, with earlier ambulation (12.3 ± 3.5 hours vs. 17.4 ± 4.1 hours, p < 0.01) and shorter hospital stays (2.8 ± 0.7 days vs. 3.6 ± 1.1 days, p < 0.01).

Conclusion: Multimodal analgesia offered better pain management than opioid-based regimens and resulted in substantial opioid use and associated side effects. It was also shown to cause quicker functional recovery, reduced hospitalization, and, therefore, was a more desirable mode of analgesia in general surgery patients.