Evidence map›Paper›PMID 34281910›Full record

ArticleBMJ open quality2021

Increasing the use of multimodal analgesia during adult surgery in a tertiary academic anaesthesia department.

Andrea V Olmos, Sasha Steen, Christy K Boscardin, Joyce M Chang, Genevieve Manahan, Anthony R Little, Man-Cheung Lee, Linda L Liu

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Article in BMJ open quality, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Trial
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Andrea V OlmosDepartment of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA.
Sasha SteenDepartment of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA.
Christy K BoscardinDepartment of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA.
Joyce M ChangDepartment of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA.
Genevieve ManahanDepartment of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA.
Anthony R LittleDepartment of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA.
Man-Cheung LeeDepartment of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA.
Linda L LiuDepartment of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA linda.liu@ucsf.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveMultimodal analgesia pathways have been shown to reduce opioid use and side effects in surgical patients. A quality improvement initiative was implemented to increase the use of multimodal analgesia in adult patients presenting for general anaesthesia at an academic tertiary care centre. The aim of this study was to increase adoption of a perioperative multimodal analgesia protocol across a broad population of surgical patients. The use of multimodal analgesia was tracked as a process metric. Our primary outcome was opioid use normalised to oral morphine equivalents (OME) intraoperatively, in the postanaesthesia care unit (PACU), and 48 hours postoperatively. Pain scores and use of antiemetics were measured as balancing metrics.

methodsWe conducted a quality improvement study of a multimodal analgesia protocol implemented for adult (≥18 and≤70) non-transplant patients undergoing general anaesthesia (≥180 min). Components of multimodal analgesia were defined as (1) preoperative analgesic medication (acetaminophen, celecoxib, diclofenac, gabapentin), (2) regional anaesthesia (peripheral nerve block or catheter, epidural catheter or spinal) or (3) intraoperative analgesic medication (ketamine, ketorolac, lidocaine infusion, magnesium, acetaminophen, dexamethasone ≥8 mg, dexmedetomidine). We compared opioid use, pain scores and antiemetic use for patients 1 year before (baseline group-1 July 2018 to 30 June 2019) and 1 year after (implementation group-1 July 2019 to 30 June 2020) project implementation.

resultsUse of multimodal analgesia improved from 53.9% in the baseline group to 67.5% in the implementation group (p<0.001). There was no significant difference in intraoperative OME use before and after implementation (β

conclusionA perioperative pragmatic multimodal analgesic intervention was associated with reduced OME use in the PACU and 48 hours postoperatively.

Indexed as

AnalgesiaAnesthesia Department, HospitalAdultAnalgesics, OpioidHumansPain MeasurementPostoperative PainAnalgesics, Opioidanaesthesiapain managementquality improvement

Identifiers

PMID34281910
PMCPMC8291327

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.