A System-Wide Multimodal Pain Management: A Quality Improvement Initiative to Reduce Opioid Use

Area of Science:

• Pain Management
• Surgical Outcomes
• Multimodal Analgesia

Background:

• Implementing hospital-wide pain management models is crucial for optimizing surgical recovery.
• Multimodal analgesia (MMA) strategies aim to reduce opioid dependence and improve patient outcomes.
• Evaluating the impact of MMA on postoperative pain, opioid consumption, and recovery metrics is essential.

Purpose of the Study:

• To assess the effectiveness of a hospital-wide multimodal analgesia (MMA) model in adults undergoing appendectomy or cholecystectomy.
• To determine changes in postoperative outcomes and opioid consumption after MMA implementation.
• To evaluate the impact of MMA on pain scores, inflammatory markers, and hospital length of stay (HLoS).

Main Methods:

• Retrospective cohort study comparing two periods (2016-2018 vs. 2019-2022) at a single tertiary hospital.
• Included 3,658 adult patients undergoing appendectomy or cholecystectomy.
• Analyzed demographics, VAS pain scores, CRP, WBC, medication use, complications, and HLoS.

Main Results:

• Nonopioid analgesic use increased significantly (40.1% to 73.6%), while opioid use decreased (80.2% to 74.5%).
• Mean VAS pain scores slightly increased (5.69 to 5.98), potentially due to improved reporting.
• Mean C-reactive protein (CRP) levels decreased substantially (70.3 to 14.1), and HLoS showed a modest reduction (2.19 to 1.9 days).

Conclusions:

• A systematic, hospital-wide MMA model led to increased nonopioid and reduced opioid consumption.
• The MMA model was associated with decreased CRP levels and a trend toward shorter HLoS.
• Further rigorous studies are needed to confirm these findings before widespread adoption for diverse surgical procedures.