The Effect of Multimodal Analgesia on Postoperative Pain Management: A Study From a Pain-Free Hospital Project

We identified significant gaps in perioperative pain management for sports medicine surgery at our hospital, including a high incidence of severe postoperative pain possibly due to a lack of preemptive analgesia.

We aimed to improve pain management outcomes by optimizing multimodal analgesia, which was implemented by the "Pain-Free Hospital" project at Peking University Third Hospital.

A single-center retrospective observational study.

Peking University Third Hospital.

A total of 6,610 sports medicine surgery patients seen from July 2022 through August 2023 were divided into baseline (the first 3 months) and intervention (the subsequent 11 months) phases. Data on postoperative Numeric Rating Scale (NRS-11) pain scores and analgesic utilization were extracted from the hospital information system. Analgesic consumption was measured by the Analgesic Use Rate (AUR) and Number of Defined Daily Doses (DDDs). The DDD value of each drug is provided by the World Health Organization (WHO). The proportion of Days with Severe Pain (DSP, NRS-11 ≥ 7) was assessed on the first postoperative day and over the first 3 days.

We addressed the gap in preemptive analgesia, with its implementation rate increasing from 0% to 53.8%. Etoricoxib (not approved for use in the United States by the FDA) use increased significantly (AUR: 13.4% to 53.2%; DDDs: 116.0 to 433.1), while pethidine use decreased significantly (AUR: 48.5% to 19.6%; DDDs: 47.1 to 17.0). These changes were accompanied by significant reductions in severe postoperative pain: DSP declined from 21.3% to 8.8% on the first postoperative day and from 10.8% to 4.8% over the first 3 days.

As a single-center retrospective study in a tertiary hospital in the People's Republic of China's capital, the regional patient pool may limit the generalizability of our findings. Additionally, the study did not account for the potential effect of COVID-19 on patient severity, surgical patterns, and analgesic prescription diversity during the pandemic.

Our study demonstrates that implementing a structured perioperative protocol emphasizing preemptive analgesia and multimodal analgesia resulted in pain management effects, including decreased incidences of severe postoperative pain and reduced analgesic opioid consumption.