Multimodal anesthesia: integrated strategies to improve pain management and recovery: a literature review
DOI:
https://doi.org/10.56183/soar.v7iEBOA7.41Keywords:
Multimodal anesthesia, pain management; patient recovery; postoperative painAbstract
With the overprescription of opioids fueling the opioid epidemic, postoperative pain management has emerged as a crucial component of surgical treatment. The shift to multimodal anesthesia as a substitute for postoperative pain management is examined in this review of the literature, with a focus on the contribution of ERAS protocols to lower opioid use and enhance patient outcomes. A methodical exploration of PubMed, Google Scholar, and Scopus was carried out to ascertain pertinent publications released during the last five years. Included were articles on non-opioid analgesics, local anesthetic, regional anesthesia, and multimodal analgesia approaches. Targeting different pain pathways and lowering opioid use, multimodal anesthesia incorporates a number of drugs and strategies, such as NSAIDs, acetaminophen, gabapentin, dexamethasone, and NMDA receptor antagonists. Research indicates that multimodal anesthesia is beneficial in lowering postoperative pain, improving healing, and minimizing opioid-related side effects in a variety of surgical specialties. By placing an emphasis on customized preoperative and postoperative therapies, the use of ERAS protocols further optimizes perioperative care. Multimodal anesthesia reduces postoperative pain, shortens hospital stays, and enhances patient satisfaction, according to studies. Nevertheless, obstacles including insufficient funding and poor training prevent regional anesthesia methods from being widely used. To address the effects of the opioid crisis on patient health and healthcare systems, as well as to advance surgical treatment, it is imperative that multimodal anesthesia procedures be clinically implemented and researched further.
References
Auty, S. G., & Griffith, K. N. (2022). Medicaid expansion and drug overdose mortality during the COVID-19 pandemic in the United States. Drug and Alcohol Dependence, 232. https://doi.org/10.1016/J.DRUGALCDEP.2022.109340
Beloeil, H. (2019). Opioid-free anesthesia. Best Practice & Research. Clinical Anaesthesiology, 33(3), 353–360. https://doi.org/10.1016/J.BPA.2019.09.002
Beverly, A., Kaye, A. D., Ljungqvist, O., & Urman, R. D. (2017). Essential Elements of Multimodal Analgesia in Enhanced Recovery After Surgery (ERAS) Guidelines. Anesthesiology Clinics, 35(2), e115–e143. https://doi.org/10.1016/j.anclin.2017.01.018
Bisch, S. P., Jago, C. A., Kalogera, E., Ganshorn, H., Meyer, L. A., Ramirez, P. T., Dowdy, S. C., & Nelson, G. (2021). Outcomes of enhanced recovery after surgery (ERAS) in gynecologic oncology – A systematic review and meta-analysis. Gynecologic Oncology, 161(1), 46–55. https://doi.org/10.1016/J.YGYNO.2020.12.035
Brown, E. N., Pavone, K. J., & Naranjo, M. (2018). Multimodal general anesthesia: Theory and practice. Anesthesia and Analgesia, 127(5), 1246–1258. https://doi.org/10.1213/ANE.0000000000003668
Brown, J. K., Singh, K., Dumitru, R., Chan, E., & Kim, M. P. (2018). The Benefits of Enhanced Recovery After Surgery Programs and Their Application in Cardiothoracic Surgery. Methodist DeBakey Cardiovascular Journal, 14(2), 77–88. https://doi.org/10.14797/MDCJ-14-2-77
Cavallaro, P., & Bordeianou, L. (2019). Implementation of an ERAS Pathway in Colorectal Surgery. Clinics in Colon and Rectal Surgery, 32(2), 102–108. https://doi.org/10.1055/S-0038-1676474
De Jong, R., & Shysh, A. J. (2018). Development of a Multimodal Analgesia Protocol for Perioperative Acute Pain Management for Lower Limb Amputation. Pain Research & Management, 2018. https://doi.org/10.1155/2018/5237040
Deshler, B. J., Rockenbach, E., Patel, T., Monahan, B. V., & Poggio, J. L. (2023). Current update on multimodal analgesia and nonopiate surgical pain management. Current Problems in Surgery, 60(6), 101332. https://doi.org/10.1016/J.CPSURG.2023.101332
Dong, W., An, B., Wang, Y., Cui, X., & Gan, J. (2021). Effect of multimodal analgesia on gynecological cancer patients after radical resection. American Journal of Translational Research, 13(4), 2686. /pmc/articles/PMC8129368/
Elsharkawy, H., El-Boghdadly, K., & Barrington, M. (2019). Quadratus Lumborum Block: Anatomical Concepts, Mechanisms, and Techniques. Anesthesiology, 130(2), 322–335. https://doi.org/10.1097/ALN.0000000000002524
FDA warns about serious breathing problems with seizure and nerve pain medicines gabapentin (Neurontin, Gralise, Horizant) and pregabalin (Lyrica, Lyrica CR) | FDA. (n.d.). Retrieved May 8, 2024, from https://www.fda.gov/drugs/drug-safety-and-availability/fda-warns-about-serious-breathing-problems-seizure-and-nerve-pain-medicines-gabapentin-neurontin
Forkin, K. T., Mitchell, R. D., Chiao, S. S., Song, C., Chronister, B. N. C., Wang, X. Q., Chisholm, C. A., & Tiouririne, M. (2022). Impact of timing of multimodal analgesia in enhanced recovery after cesarean delivery protocols on postoperative opioids: A single center before-and-after study. Journal of Clinical Anesthesia, 80, 110847. https://doi.org/10.1016/J.JCLINANE.2022.110847
Gabriel, R. A., & Ilfeld, B. M. (2018). Use of Regional Anesthesia for Outpatient Surgery Within the United States: A Prevalence Study Using a Nationwide Database. Anesthesia and Analgesia, 126(6), 2078–2084. https://doi.org/10.1213/ANE.0000000000002503
Gustafsson, U. O., Scott, M. J., Hubner, M., Nygren, J., Demartines, N., Francis, N., Rockall, T. A., Young-Fadok, T. M., Hill, A. G., Soop, M., de Boer, H. D., Urman, R. D., Chang, G. J., Fichera, A., Kessler, H., Grass, F., Whang, E. E., Fawcett, W. J., Carli, F., … Ljungqvist, O. (2019). Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations: 2018. World Journal of Surgery, 43(3), 659–695. https://doi.org/10.1007/S00268-018-4844-Y
Hah, J., Mackey, S. C., Schmidt, P., McCue, R., Humphreys, K., Trafton, J., Efron, B., Clay, D., Sharifzadeh, Y., Ruchelli, G., Goodman, S., Huddleston, J., Maloney, W. J., Dirbas, F. M., Shrager, J., Costouros, J. G., Curtin, C., & Carroll, I. (2018). Effect of Perioperative Gabapentin on Postoperative Pain Resolution and Opioid Cessation in a Mixed Surgical Cohort: A Randomized Clinical Trial. JAMA Surgery, 153(4), 303–311. https://doi.org/10.1001/JAMASURG.2017.4915
Jibril, F., Sharaby, S., Mohamed, A., & Wilby, K. J. (2015). Intravenous versus Oral Acetaminophen for Pain: Systematic Review of Current Evidence to Support Clinical Decision-Making. The Canadian Journal of Hospital Pharmacy, 68(3), 238. https://doi.org/10.4212/CJHP.V68I3.1458
Joshi, G. P., Kehlet, H., & Rawal, N. (2019). Surgeon-administered regional analgesia to replace anaesthetist-administered regional analgesia: need for communication and collaboration. British Journal of Anaesthesia, 123(6), 707–709. https://doi.org/10.1016/J.BJA.2019.08.020
Kaul, I., Amin, A., Rosenberg, M., Rosenberg, L., & Meyer, W. J. (2018). Use of gabapentin and pregabalin for pruritus and neuropathic pain associated with major burn injury: A retrospective chart review. Burns: Journal of the International Society for Burn Injuries, 44(2), 414–422. https://doi.org/10.1016/J.BURNS.2017.07.018
Kelley, B. P., Chung, K. C., Chung, T. T., Bennett, K. G., Sacks, G., Sears, E. D., & Waljee, J. F. (2018). Postoperative Ketorolac in Breast and Body Contouring Procedures: A Nationwide Claims Analysis. Plastic and Reconstructive Surgery, 142(4), 472E-480E. https://doi.org/10.1097/PRS.0000000000004806
Kim, D. H., Oh, Y. J., Lee, J. G., Ha, D., Chang, Y. J., & Kwak, H. J. (2018). Efficacy of Ultrasound-Guided Serratus Plane Block on Postoperative Quality of Recovery and Analgesia After Video-Assisted Thoracic Surgery: A Randomized, Triple-Blind, Placebo-Controlled Study. Anesthesia and Analgesia, 126(4), 1353–1361. https://doi.org/10.1213/ANE.0000000000002779
Kogler, V. M., Katušin, M. L., & Kogler, J. (2023). Evidence-Based Strategies for Multimodal Postoperative Pain Management. Acta Clínica Croatica, 62, 107–114. https://doi.org/10.20471/acc.2023.62.s4.16
Martins, T. P., Souza, D. M., & Souza, D. M. (2023). Use of multimodal anesthesia in the treatment of postoperative pain. BrJP, 6(4), 427–434. https://doi.org/10.5935/2595-0118.20230075-EN
Mishriky, B. M., Waldron, N. H., & Habib, A. S. (2015). Impact of pregabalin on acute and persistent postoperative pain: a systematic review and meta-analysis. British Journal of Anaesthesia, 114(1), 10–31. https://doi.org/10.1093/BJA/AEU293
Moore, R. A., Derry, S., Aldington, D., & Wiffen, P. J. (2015). Single dose oral analgesics for acute postoperative pain in adults - an overview of Cochrane reviews. The Cochrane Database of Systematic Reviews, 2015(9). https://doi.org/10.1002/14651858.CD008659.PUB3
Mungroop, T. H., Bond, M. J., Lirk, P., Busch, O. R., Hollmann, M. W., Veelo, D. P., & Besselink, M. G. (2019). Preperitoneal or Subcutaneous Wound Catheters as Alternative for Epidural Analgesia in Abdominal Surgery: A Systematic Review and Meta-analysis. Annals of Surgery, 269(2), 252–260. https://doi.org/10.1097/SLA.0000000000002817
Murphy, S. M. (2020). The cost of opioid use disorder and the value of aversion. Drug and Alcohol Dependence, 217. https://doi.org/10.1016/J.DRUGALCDEP.2020.108382
Nissen, S. E., Yeomans, N. D., Solomon, D. H., Lüscher, T. F., Libby, P., Husni, M. E., Graham, D. Y., Borer, J. S., Wisniewski, L. M., Wolski, K. E., Wang, Q., Menon, V., Ruschitzka, F., Gaffney, M., Beckerman, B., Berger, M. F., Bao, W., & Lincoff, A. M. (2016). Cardiovascular Safety of Celecoxib, Naproxen, or Ibuprofen for Arthritis. The New England Journal of Medicine, 375(26), 2519–2529. https://doi.org/10.1056/NEJMOA1611593
Pawa, A., & El-Boghdadly, K. (2018). Regional anesthesia by nonanesthesiologists. Current Opinion in Anaesthesiology, 31(5), 586–592. https://doi.org/10.1097/ACO.0000000000000643
Polderman, J. A. W., Farhang-Razi, V., van Dieren, S., Kranke, P., DeVries, J. H., Hollmann, M. W., Preckel, B., & Hermanides, J. (2019). Adverse side-effects of dexamethasone in surgical patients - an abridged Cochrane systematic review. Anaesthesia, 74(7), 929–939. https://doi.org/10.1111/ANAE.14610
Rivedal, D. D., Nayar, H. S., Israel, J. S., Leverson, G., Schulz, A. J., Chambers, T., Afifi, A. M., Blake, J. M., & Poore, S. O. (2018). Paravertebral block associated with decreased opioid use and less nausea and vomiting after reduction mammaplasty. The Journal of Surgical Research, 228, 307–313. https://doi.org/10.1016/J.JSS.2018.03.018
Rodrigues, L. G., & Palotti, A. M. (2022). Anestesia multimodal em pacientes submetidos à cirurgia bariátrica (gastroplastia por bypass gástrico): relato de experiência / Multimodal anesthesia in patients undergoing bariatric surgery (gastric bypass gastroplasty): experience report. Brazilian Journal of Health Review, 5(1), 507–517. https://doi.org/10.34119/BJHRV5N1-042
Roy, C. F., Azzi, A. J., & Davison, P. (2019). A Review of Wound Infusion with Local Anesthetics in Plastic Surgery. Annals of Plastic Surgery, 83(6), e110–e117. https://doi.org/10.1097/SAP.0000000000001916
Schoenbrunner, A. R., Joshi, G. P., & Janis, J. E. (2022). Multimodal Analgesia in the Aesthetic Plastic Surgery: Concepts and Strategies. Plastic and Reconstructive Surgery Global Open, 10(5), E4310. https://doi.org/10.1097/GOX.0000000000004310
Singer, K. E., Philpott, C. D., Bercz, A. P., Phillips, T., Salyer, C. E., Hanseman, D., Droege, M. E., Goodman, M. D., & Makley, A. T. (2021). Impact of a Multimodal Analgesia Protocol on Inpatient and Outpatient Opioid Use in Acute Trauma. Journal of Surgical Research, 268, 9–16. https://doi.org/10.1016/J.JSS.2021.05.052
Soffin, E. M., Lee, B. H., Kumar, K. K., & Wu, C. L. (2019). The prescription opioid crisis: role of the anaesthesiologist in reducing opioid use and misuse. BJA: British Journal of Anaesthesia, 122(6), e198. https://doi.org/10.1016/J.BJA.2018.11.019
Toleska, M., Dimitrovski, A., Shosholcheva, M., Kartalov, A., Kuzmanovska, B., & Dimitrovska, N. T. (2022). Pain and Multimodal Analgesia in Laparoscopic Cholecystectomy. Prilozi (Makedonska Akademija Na Naukite i Umetnostite. Oddelenie Za Medicinski Nauki), 43(2), 41–49. https://doi.org/10.2478/PRILOZI-2022-0017
Volkow, N. D., Jones, E. B., Einstein, E. B., & Wargo, E. M. (2019). Prevention and Treatment of Opioid Misuse and Addiction: A Review. JAMA Psychiatry, 76(2), 208–216. https://doi.org/10.1001/JAMAPSYCHIATRY.2018.3126
Walker, N. J., Jones, V. M., Kratky, L., Chen, H., & Runyan, C. M. (2019). Hematoma Risks of Nonsteroidal Anti-inflammatory Drugs Used in Plastic Surgery Procedures: A Systematic Review and Meta-analysis. Annals of Plastic Surgery, 82(6S Suppl 5), S437–S445. https://doi.org/10.1097/SAP.0000000000001898
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Andrés Sebastián Viteri Hinojosa
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.