Routes of postoperative analgesia administration in surgical wards: practice vs. guidelines and economic implications.

Introduction: Multimodal analgesia, critical to postoperative recovery, typically involves oral (PO), intravenous (IV), or regional analgesia. The PO route is preferred for its non-invasive nature, cost-effectiveness, and comparable efficacy to parenteral routes. This study assessed whether analgesic practices in surgical wards align with current guidelines and evaluated the economic impact of deviations. Materials and methods: Data from 2,354 adult patients, collected using the PAIN OUT methodology across 10 Serbian hospitals, were analyzed. Patients undergoing various surgeries were observed during the first 24 h postoperatively. We analyzed analgesic administration routes on surgical wards for the entire cohort and a subgroup where PO administration was deemed feasible. Potential savings of transitioning from parenteral to PO were calculated, including medication, disposables, and labor costs. Results: In the entire cohort, the IV route was used in 86% of patients receiving non-opioids and 39% receiving opioids, while the IM route was used in 7 and 4%, respectively. The PO route was employed in only 1% of patients. Among 1,850 patients for whom the PO route was considered feasible, the IV route was used in 86% for non-opioids and 38% for opioids, and the IM route in 8 and 5%, respectively. Transitioning from parenteral to PO administration would reduce costs from 822.3 RSD (7.84 USD) to 124.5 RSD (1.19 USD) per patient, resulting in 85% savings. Conclusion: The reliance on IV analgesia and underuse of PO route in Serbia reveals a gap between practice and guidelines. Transitioning to PO analgesia could result in significant cost savings.