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Multimodal Analgesia: Move Better, Quicker After Surgery with Fewer Side Effects

Image - Photo of Kanupriya Kumar, MD
Kanupriya Kumar, MD
Assistant Attending Anesthesiologist, Hospital for Special Surgery
Clinical Assistant Professor of Anesthesiology, Weill Cornell Medical College

Multimodal analgesia refers to the practice of combining different types of medications for pain management. Using multimodal analgesia techniques to manage short-term pain (called acute pain) enables anesthesiologists to maximize pain relief after surgery while minimizing side effects.

Pain relief medication can be administered in a variety of ways:

  • Local anesthetic (numbing medication) injections used in nerve blocks and epidurals
  • Intravenously
  • Orally (pill form)
  • Topically (for example, a patch)

The type of surgery dictates which types of pain relief techniques can be combined and in what ways (these procedure-based methods are called “multimodal analgesic pathways”). These pathways are essentially plans for how anesthesiologists can best prepare for your surgery, based on the type of pain and the expected severity of pain, as well as the requirements for rehabilitation and healing for each procedure.

The aim of multimodal analgesia is to help patients participate more fully in physically therapy, get better rest, and recover more quickly while managing their postsurgical pain and minimizing known side effects of prescription opioids (such as nausea, sedation, delirium and constipation). There is an expected progression of recovery for most surgeries; however, different factors influence how individuals navigate their recovery.

The use of standardized multimodal analgesic pathways may not be appropriate for all surgical operations or patients, but anesthesiologists at HSS always aim to provide the best possible pain relief after surgery and are available to discuss concerns regarding pain management. Even if a formal pathway is not indicated for a particular operation or patient, certain multimodal analgesic techniques may be used after a discussion with the patient, surgeon and anesthesiologist.

Multimodal Analgesia at HSS

Most multimodal analgesic pathways used at HSS begin in the operating room when the anesthesiologist performs the nerve blocks and epidurals while the patient is under sedation. Some pathways, however, are initiated in the preoperative holding area. Depending on the particular pathway, a patient may receive a patch and/or a combination of pills which will begin to take effect before surgery.

At HSS, every physician within the Department of Anesthesiology, Critical Care & Pain Management is well versed in using multimodal analgesic techniques. Many of our anesthesiologists examine the impact of multimodal analgesia on patient satisfaction and surgical outcomes, as well as how the use of these pathways can continue to improve patient care.

 Multimodal Analgesia and Opioids

Research suggests that patients who undergo joint replacement surgeries benefit from multimodal analgesic strategies. Investigators at HSS have been looking at the impact of multimodal analgesia techniques. So far, the data has demonstrated a link between multimodal analgesic strategies and reduced opioid consumption in the 1 to 2 weeks after surgery, fewer days spent in the hospital, and higher patient satisfaction scores.

While prescription pain medication is often required in the short-term after surgery, using complementary non-opioid pain relief methods may result in patients needing fewer opioids overall, while allowing for appropriate rehabilitation and recovery.

 

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