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Multimodal Pain Relief Strategies May Improve Outcomes in Sleep Apnea Patients

New York, NY—April 19, 2018

Multimodal analgesia - a strategy used by anesthesiologists to combine different modes of pain relief before, during, and after surgery - may significantly lower opioid consumption and other complications in patients with obstructive sleep apnea (OSA) undergoing orthopedic surgery, according to researchers from Hospital for Special Surgery (HSS).

Due to the impact of OSA on breathing function, patients affected by this condition are at increased risk from the effects of anesthetic medications and specifically opioid drugs delivered during surgery, explained the investigators at the 2018 World Congress on Regional Anesthesia and Pain Medicine poster presentation.

"Multimodal analgesia has become increasingly popular, but there is a lack of large-scale population-based data on the practice and impact of these techniques on patients with OSA," said co-author and presenter Crispiana Cozowicz, MD, a perioperative research fellow within the Clinical Research Division of the Department of Anesthesiology, Critical Care & Pain Management at HSS.

Dr. Cozowicz and a team of researchers looked at opioid dose and post-operative outcomes in 181,182 patients undergoing total hip or total knee replacements enrolled in the Premier Perspective database from 2006 to 2016. Multimodal analgesia was defined as opioid use with the addition of one, two, or more non-opioid pain relief modes including peripheral nerve blocks, acetaminophen, steroids, gabapentin/pregabalin, non-steroidal anti-inflammatories (NSAIDs), COX-2 inhibitors, or ketamine.

The prevalence of multimodal analgesia strategies was 88.5 percent, and the use of multimodal analgesia increased over time, reported the investigators. Increasing modes of analgesia were associated with a significant decrease in opioid dose prescription. Most importantly, the need for postoperative mechanical ventilation, representing life-threatening respiratory failure as well as critical care admissions decreased in patients who received multiple types of pain relief. Furthermore, the use of multimodal pain management strategies was associated with reduced hospital length of stay.

"Multimodal analgesia may significantly decrease postoperative opioid consumption and severe complications in patients with OSA," said Stavros Memtsoudis, MD, PhD, FCCP, and senior scientist and anesthesiologist within the Department of Anesthesiology at HSS.  


Crispiana Cozowicz MD, Lukas Pichler MD, Jashvant Poeran MD PhD, Nicole Zubizarreta MPH, Madhu Mazumdar PhD, Stavros G. Memtsoudis MD PhD FCCP. "Multimodal analgesia in OSA is associated with reduction in severe respiratory complications, critical care admissions and resource utilization in orthopedic surgery." Presented at: 2018 World Congress on Regional Anesthesia and Pain Medicine, April 19 – 21; New York, NY.


About HSS | Hospital for Special Surgery
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the ninth consecutive year) and No. 3 in rheumatology by U.S.News & World Report (2018-2019). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In 2017 HSS provided care to 135,000 patients and performed more than 32,000 surgical procedures. People from all 50 U.S. states and 80 countries travelled to receive care at HSS. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The culture of innovation is accelerating at HSS as 130 new idea submissions were made to the Global Innovation Institute in 2017 (almost 3x the submissions in 2015). The HSS Education Institute is the world’s leading provider of education on the topic on musculoskeletal health, with its online learning platform offering more than 600 courses to more than 21,000 medical professional members worldwide. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally.


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