Perioperative medicine & outcomes
Optimal multimodal analgesia combinations to reduce pain and opioid use following non-cardiac surgery: an instrumental variable analysis
Authors' conclusion
Our findings further support existing evidence on the effectiveness of MMA in reducing postoperative pain and opioid use following non-cardiac surgery.
Study context
- Population
- Patients undergoing elective non-cardiac surgery with GA at six Veterans Health Administration hospitals, 2017–2022
- Participants
- 23,238 procedures
- Exposure
- MMA vs no MMA; non-opioid medication combinations
- Outcome
- Self-reported pain and opioid use after surgery
Methodological detailsinstrumental variable analysis, multicentre
- Instrumental variable analysis
- Multicentre
Main finding
As reported in the abstract
Difference
6.8 fewer OMEs
95% CI −10.2, to −3.4
inpatients, postoperative opioid use; Instrumental variable (IV) analysis
Difference
1.0 unit lower
95% CI −1.6 to −0.4
outpatients, postoperative pain scores; IV analysis
- Received MMA
- 46.1%
Observational data: associations, not effects.
Further findings
Postoperative opioid use by non-opioid combination
| Mean reduction (OMEs) (95% CI) | ||
|---|---|---|
| NSAIDs plus dexamethasone | −29.5 (−36.9 to −19.5) | |
| NSAIDs plus RA | −28.4 (−40.1 to −16.8) | |
| −60−40−20020Difference, OMEs (linear scale) |
- Greatest reductions in postoperative opioid use
Characteristics of MMA recipients
- MMA more common in younger patients, females and those with lower probability of mortality
Original publication
Optimal multimodal analgesia combinations to reduce pain and opioid use following non-cardiac surgery: an instrumental variable analysis. Reg Anesth Pain Med. Published 13 July 2025. doi:10.
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