Dissemination and Impact of a Multimodal Pain Regimen on Analgesia Prescribing at an Academic Hospital

An opioid-sparing, multimodal pain (MMP) protocol was initiated at our institution in August 2016 in the Division of Trauma and Acute Care Surgery (TACS). During the next year, the practice was codified into a protocol. This study aims to evaluate the dissemination and impact of MMP.

We conducted a single-center retrospective cohort study of all patients admitted to a surgical service from May 2015 to July 2020 to evaluate opioid and nonopioid prescribing for analgesia. The analysis consisted of three populations: patients admitted to the TACS service, the General Surgery subspecialty (GSS) services (excluding TACS), and other surgical department (OSD) services.

Of the 12,010 patients who met the inclusion criteria, 1979 (16.5%) were admitted to the TACS service, 1106 (9.2%) to GSS services, and 8925 (74.3%) to OSD services. Opioid morphine milligram equivalents averaged 38.6 ± 33.3 daily but decreased in all groups over time. Nonopioid adjunctive medications were used in 5932 (49.4%) and increased in all groups after implementation of the protocol (all P < 0.001). After MMP introduction, nonopioid analgesic use increased most rapidly in TACS and the slowest in OSD. Conversely, the average daily morphine milligram equivalents decreased most quickly in TACS (24.4%, P < 0.001), while GSS and OSD services saw a subsequent decrease in opioid use (P = 0.004 and P < 0.001, respectively) as MMP increased.

Implementation of an MMP protocol by a single division can facilitate the spread of nonopioid adjunctive pain medication use and decrease opioid utilization throughout surgical specialties in a hospital.