Variations in Current Practice and Protocols of Intraoperative Multimodal Analgesia: A Cross-Sectional Study Within a Six-Hospital US Health Care System
Authors' conclusion
In a large integrated US health care system, approximately 50% of noncardiac surgery patients received MMA. Still, there was wide variation in MMA use by patient and procedure characteristics and across hospitals and anesthesiologists.
Study context
- Population
- All patients undergoing surgery with GA at 1 of 6 US hospitals, January 1, 2017 to December 31, 2022
- Participants
- 21,227 patients · 25,386 procedures
- Outcome
- MMA use (opioid plus ≥2 other nonopioid analgesics): change over time and variation by patient, provider and facility characteristics
Methodological detailsmulticentre (6 hospitals), multivariable logistic regression
- Multicentre (6 hospitals)
- Multivariable logistic regression
Main finding
As reported in the abstract
Cases meeting MMA definition
46.9%
Average yearly increase in MMA use since 2017
3.0%
95% CI 2.6%–3.3%
Variation across hospitals (n = 6), range; χ 2 = 3774.9, P < .001
25.9%-68.6%
Variation across anesthesiologists (n = 190), IQR; χ 2 = 1938.5, P < .001
29.8%-65.8%
Observational data: associations, not effects.
Further findings
Most common MMA protocols
- Acetaminophen plus RA (% of protocols)
- 13.0%
- Acetaminophen plus dexamethasone (% of protocols)
- 12.2%
Change in analgesic use over study period (% of cases) · 2017–2022
- Opioids (preoperative or intraoperative) decreased
- 91.4% to 86.0%
- Acetaminophen increased (P < .001)
- 41.9%-70.5%
- Dexamethasone increased (P < .001)
- 24.0%-36.1%
- Nonsteroidal anti-inflammatory drugs (NSAIDs) increased (P < .001)
- 6.9%-17.3%
- Gabapentinoids increased (P < .001)
- 0.8%-1.6%
- IV lidocaine increased (P < .001)
- 3.4%-5.3%
Original publication
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