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Acute pain can be excruciatingly high after surgery and patients need support to help them deal with this agony. An effective pain management plan can help patients recover faster and reduce complications after surgery.1,2 Traditionally, postoperative pain management relied on narcotics like opioids.

However, in recent years, more providers have been turning to multimodal pain management as the preferred way to manage pain after surgery. In fact, it is now the standard of care for total joint surgeries and many other elective procedures.

What is multimodal pain management?

Multimodal pain management is the method of treating postoperative pain using a mix of different types of systemic and local analgesic medications like:

  • Acetaminophen (Tylenol) – oral and intravenous
  • NSAIDs like Advil
  • Gabapentin (preoperative)
  • Ketamine
  • Peripheral nerve blocks and more

Along with medication, providers may use devices like compression stockings or sleeves, pain pumps, and more to ease a patient’s pain after surgery.

Benefits of multimodal pain management


An opioid-sparing approach works well in treating postoperative pain. It has been shown to provide pain relief, and reduce adverse effects after surgery. A huge benefit is that this type of treatment can be a powerful way to lower levels of opioid dependency in the country.

Over the past few decades, America has been in the throes of a massive opioid crisis caused by the over-prescription and misuse of narcotics. According to the CDC, 187 people die from opioid overdose, every day.

Research shows that 5.9% of patients who underwent minor surgical procedures and 6.5% of those who underwent intensive surgeries become persistent opioid users. 15% of patients develop opioid dependence after total knee arthroplasty (TKA) surgery.3 A CDC report shows that even ten days on opioids can lead to opioid dependency.4

Multimodal pain management provides healthcare professionals and patients alike with a better alternative.

Reduced adverse effects after surgery

Opioids can cause a multitude of postoperative issues, like nausea, vomiting, constipation, urinary retention, cardiac abnormalities, respiratory issues, and even extreme sensitivity to pain (hyperalgesia).2,5,6

But the biggest problem with opioids is their highly addictive nature. Commonly used opioids are morphine, fentanyl, methadone, and tramadol. The World Health Organization (WHO) estimates that out of all deaths from drug use, 70% are related to opioids, and over 30% of these deaths are caused by overdose. Minimizing opioid use after surgery can help reduce postoperative complications and the risk of addiction.7

An opioid-sparing approach also lowers the risk of drug diversion when prescription medicines are procured and used illegally. According to the Centers for Medicare and Medicaid Services (CMS), more than a million people a year end up in emergency rooms for taking medications incorrectly.8

Very effective for at-home recovery after outpatient surgery in ASCs

Ambulatory Surgery Centers (ASCs) are becoming popular destinations for outpatient procedures. Patients prefer the cost-efficient low-risk procedures and same-day discharges that ASCs offer. However, with patients getting discharged soon after surgery, pain management at home becomes important.

Most patients suffer severe to moderate pain within 24-48 hours after surgery. Still, less than half report satisfactory postoperative pain relief.9,10 Pain control after surgery is important to help patients reduce post-surgical complications, get mobile faster, and ease recovery. However, many patients are highly dissatisfied with their pain management solutions.11-13

Surgeons need simple, user-friendly pain protocols for patients to follow. An opioid-sparing approach can be highly beneficial.

How is multimodal pain medication delivered to patients?

Multimodal pain management is often a combination of oral and intravenous medication based on each patient’s needs. Oral medicines may take a little longer to offer pain relief than intravenous methods, but it is easier to taper patients off these therapies.

Many ASCs also use pain management devices to help deliver analgesics in a controlled fashion. Patient-controlled analgesia (PCA) can help surgeons and their patients control breakthrough pain and manage their medication dose easily. Pain pumps like the ambIT electronic pain pump can be pre-programmed to deliver the correct dose at the right time.

The ambit pump has been proven to reduce opioid use significantly and shorten hospital stays.14,15 Another benefit of PCA is that it can be personalized based on each patient’s needs. Healthcare professionals can create and administer a custom multimodal pain management strategy based on the type of surgery, comorbidities, and other parameters. This way, patients can take charge and be actively engaged in their recovery.

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1. Joshi GP, Kehlet H Enhanced recovery pathways: looking into the future. Anesth Analg. 2019;128:5–7.

2. Joshi GP, Kehlet H Postoperative pain management in the ear of ERAS: an overview. Best Prac Res Clin Anaesthesiol. 2019;33:259–267.

3. Biosciences, P. (2011). Exposing a silent gateway to persistent opioid use, a Choices Matter status report. Retrieved from https://www.planagainstpain.com/wp-content/uploads/2019/06/ChoicesMatter_Report_2018.pdf

4. Barker, J. C., Joshi, G. P., & Janis, J. E. (2020). Basics and best practices of multimodal pain management for the plastic surgeon. Plastic and Reconstructive Surgery. Global Open, 8(5), e2833. doi:10.1097/GOX.0000000000002833

5. Trasolini, N. A., McKnight, B. M., & Dorr, L. D. (2018). The opioid crisis and the orthopedic surgeon. The Journal of Arthroplasty, 33(11), 3379-3382.e1. doi:10.1016/j.arth.2018.07.002

6. Alexander JC, Patel B, Joshi GP Perioperative use of opioids: current controversies and concerns. Best Pract Res Clin Anaesthesiol. 2019;33:341–351.

7. Opioid overdose. (n.d.). Retrieved November 15, 2022, from Who.int website: https://www.who.int/news-room/fact-sheets/detail/opioid-overdose

8. Do you know about drug diversion? (n.d.). Retrieved November 15, 2022, from Cms.gov website: https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Downloads/infograph-Do-You-Know-About-Drug-Diversion-%5BApril-2016%5D.pdf

9. Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg 2003;97:534-40

10. Gerbershagen HJ, Aduckathil S, van Wijck AJ, et al. Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology 2013;118:934-44

11. Benhamou D, Berti M, Brodner G, et al. Postoperative Analgesic THerapy Observational Survey (PATHOS): a practice pattern study in 7 central/southern European countries. Pain 2008;136:134-41

12. Maier C, Nestler N, Richter H, et al. The quality of pain management in German hospitals. Dtsch Arztebl Int 2010;107:607-14

13. Zaslansky R, Rothaug J, Chapman CR, et al. PAIN OUT: the making of an international acute pain registry. Eur J Pain 2015;19:490-502

14. Forastiere, E., Sofra, M., Giannarelli, D., Fabrizi, L., & Simone, G. (2008). Effectiveness of continuous wound infusion of 0.5% ropivacaine by On-Q pain relief system for postoperative pain management after open nephrectomy. British Journal of Anaesthesia, 101(6), 841–847. https://doi.org/10.1093/bja/aen309

15. White, P. F., Rawal, S., Latham, P., Markowitz, S., Issioui, T., Chi, L., Dellaria, S., Shi, C., Morse, L., & Ing, C. (2003). Use of a continuous local anesthetic infusion for pain management after median sternotomy. Anesthesiology, 99(4), 918–923. https://doi.org/10.1097/00000542-200310000-00026

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