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Multimodal Pain Relief Strategies May Improve Outcomes in Sleep Apnea Patients

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.