Efficacy of Multimodal Analgesia in Reducing Opioid Consumption After Major Abdominal Surgery

Background: Major abdominal surgery frequently leaves patients in significant post-operative pain, which is usually treated with opioids. Opioids are effective analgesics but have a variety of side effects, such as sedation, delayed recovery, ileus, urinary retention, nausea, vomiting and respiratory depression. The combination of pharmacologic and non-pharmacologic analgesics with multiple methods and modalities that produce diverse effects (multimodal analgesia) has proved effective in decreasing postoperative opioid requirements and enhancing recovery. The aim is to determine the effectiveness of multimodal analgesia as a means of decreasing postoperative opioid usage after large abdominal surgery. Material and Methods: A prospective comparative study was performed in 140 patients that were undergoing elective major surgery in the abdomen, with general anesthesia. The 140 patients were randomly assigned to two groups of 70. Group M were treated with multimodal analgesia (paracetamol, non-steroidal anti-inflammatory drugs and regional techniques) and limited opioids whilst Group O was given conventional opioid-based analgesia. Opioid consumption in the postoperative period, the Visual Analogue Scale (VAS), requirement for rescue analgesics, adverse effects, time to bowel recovery, ambulation and length of stay were evaluated. Student's t-test and Chi-square test were done to analyze the statistical data. A p-value <0.05 was considered statistically significant. Results: The multimodal analgesia group had a significantly reduced amount of opioids used after surgery (p<0.001) than the conventional opioid group. In Group M, mean VAS scores at 6, 12 and 24 hours were significantly lower and incidence of nausea, vomiting, sedation and postoperative ileus was significantly lower in the multimodal group. Patients receiving multimodal analgesia were also observed to have shorter hospital stay and early ambulation. Conclusion: Multimodal analgesia leads to a substantial decrease in post-op opioid requirement and better recovery following major abdominal surgery. This technique allows for greater pain control and reduced opioid side effects while promoting improved recovery after surgery.

Keywords: Multi modal analgesia, opioid consumption, abdominal surgery, postoperative pain, enhanced recovery and regional analgesia.