An Analgesic Regimen for Opioid Reduction in Elective Plastic Surgery

A Randomized Prospective Study

Ashley Newman, B.S.; Steven P. Davison, M.D., D.D.S.

Disclosures

Plast Reconstr Surg. 2021;147(2):325e-330e. 

In This Article

Results

The statistical level of significance was set at 5 percent (p < 0.05) for all analyses. All data were analyzed using an independent two-sample t test. There was no significant difference between the demographics (mean ages, body mass index, and surgery lengths) of each group (Table 3). In the multimodal analgesia group, 38.8 percent of operations included body procedures, 46.9 percent of operations included breast procedures, and 34.7 percent of operations included facial procedures. In the standard postoperative opioid group, 37.9 percent of operations included body procedures, 45.5 percent of operations included breast procedures, and 28.8 percent of operations included facial procedures. There was no significant difference in the types of procedures performed in each group.

In the multimodal analgesia group, dosing of 1 g of acetaminophen, in the preoperative area, was chosen, to avoid any overdose issues with excess acetaminophen (maximum daily, 4 g). Gabapentin was also given in the preoperative area to ensure dosing and that all patients took the medication within the same time frame.

In the postanesthesia care unit, the multimodal analgesia group had an average 30-minute postanesthesia care unit pain score of 4.5 ± 2.1 and an average discharge score of 2.3 ± 1.6, a 50.4 percent reduction in pain throughout the postanesthesia care unit stay. The standard postoperative opioid group had an average 30-minute postanesthesia care unit pain score of 5.2 ± 2.5 and an average discharge pain score of 3.1 ± 1.8, a 40.4 percent reduction in pain throughout the postanesthesia care unit stay (Table 4). The difference between postanesthesia care unit and discharge pain scores in the multimodal analgesia group versus the standard opioid group was found to be statistically significant for both the 30-minute postanesthesia care unit and discharge pain scores, at values of p = 0.049 and p = 0.003, respectively. The average morphine equivalents given in the postanesthesia care unit was 13.1 ± 5.8 for the multimodal analgesia group and 13.1 ± 6.6 for the standard opioid group. There was no significant difference in the amount of opioids given in the postanesthesia care unit to get patients to the appropriate pain threshold for discharge (p = 0.500).

In the postoperative period, there was a 91 percent response rate (9 percent of patients were removed from the study for protocol deviations). Patients using the multimodal pain regimen used an average of 7.7 ± 5.3 opioid pain pills for 3.9 ± 2.2 days in the postoperative period, whereas those using the traditional opioid regimen used an average of 11.9 ± 8.4 opioid pain pills for 4.7 ± 3.5 days (Table 5). This represents a significant 35.0 percent reduction in the number of opioid pain pills needed in the postoperative period (p = 0.0007). Patients using the multimodal analgesia regimen demonstrated an 18.4 percent difference in the number of days to cessation of opioids; the difference was not statistically significant (p = 0.05).

All medication costs were considered as the average medication cost for a patient without insurance. The average cost of medications for a patient in the multimodal analgesia group was $48.39, whereas the cost of the medications in the standard opioid group was $39.81, a $8.58 difference in cost (Table 6).[20,22–25] The cost for the practice to stock acetaminophen and gabapentin for multimodal analgesia patients in the preoperative area was $2.40 per patient (Table 7). Prices were obtained from pharmacy bills of the practice, which matched average national prices.[20,22–25]

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