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

To evaluate whether significant changes in postoperative outcomes and opioid consumption could be detected following the implementation of a comprehensive hospital-wide pain management model centered on multimodal analgesia (MMA) among adults undergoing appendectomy or cholecystectomy.

Retrospective cohort study comparing two distinct periods at a single tertiary hospital: an Initial Phase (2016-2018), representing baseline and assimilation of the model; and a Subsequent Phase (2019-2022), reflecting the full operation of the MMA protocols.

The study included 3,658 adult patients (≥18 years) who underwent appendectomy or cholecystectomy. Data extracted from hospital records included demographics, VAS pain scores, inflammatory markers (CRP, WBC), medication use, surgical details, complications, and hospital length of stay (HLoS). Statistical analysis compared outcomes between the two phases.

Following full implementation, nonopioid analgesic use increased significantly from 40.1% to 73.6% (p < .001), while opioid use decreased from 80.2% to 74.5% (p < .001). Mean VAS scores increased modestly from 5.69 ± 1.4 to 5.98 ± 1.6 (p < .001), likely due to improved pain reporting. Mean C-Reactive Protein (CRP) levels dropped substantially from 70.3 ± 81.6 to 14.1 ± 7.4 (p < .001). Average hospital stays shortened modestly from 2.19 ± 3.4 to 1.9 ± 2.9 days (p = .5). Complication rates remained unchanged.

Following the implementation of a systematic, hospital-wide MMA pain management model, a significant increase in nonopioid consumption and a reduction in opioid use were observed. Furthermore, decreased CRP levels and a trend toward shortened HLoS postsurgery were detected during this subsequent period.

These findings document the expected changes that occurred after implementing a system-wide MMA initiative. Future replication studies using more rigorous designs are needed to confirm these effects before supporting broader adoption across diverse surgical procedures.