Evidence map›Paper›PMID 41781853›Full record

SynthesisBMC anesthesiology2026

The effect of adding a second multimodal analgesic component to anesthesia regimens on acute postoperative pain outcomes: a systematic review and meta-analysis.

Lucas T van Eijk, Sandra A S van den Heuvel, Regina L M van Boekel, Richard van der Meer, Jörgen Bruhn, Kimberley E Wever

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMC anesthesiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing 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

1 citing paper in PubMed.

  1. Article
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

6 authors.

Lucas T van EijkDepartment of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. box 9101, Nijmegen, 6500 HB, the Netherlands. lucas.vaneijk@radboudumc.nl.
Sandra A S van den HeuvelDepartment of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. box 9101, Nijmegen, 6500 HB, the Netherlands.
Regina L M van BoekelDepartment of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. box 9101, Nijmegen, 6500 HB, the Netherlands.
Richard van der MeerDepartment of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. box 9101, Nijmegen, 6500 HB, the Netherlands.
Jörgen BruhnDepartment of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. box 9101, Nijmegen, 6500 HB, the Netherlands.
Kimberley E WeverDepartment of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. box 9101, Nijmegen, 6500 HB, the Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPostoperative pain remains a common clinical challenge, affecting patient recovery, satisfaction, and risk of chronic pain. Conventional analgesics often inadequately address the multifactorial nature of postoperative pain, while opioids carry risks of adverse effects and dependence. Multimodal analgesia, combining agents with complementary mechanisms, aims to improve pain control and reduce opioid consumption, but the incremental benefit of adding a second component is unclear.

objectiveTo evaluate whether adding a second multimodal analgesic component to conventional regimens improves postoperative pain control and reduces opioid consumption in adult patients undergoing non-cardiac surgery.

methodsWe performed a systematic review and meta-analysis of randomized controlled trials. PubMed and EMBASE (via Ovid) were searched for eligible studies up to August 2, 2024, using search terms related to surgical patients, pain, multimodal analgesia, and ten common multimodal components. We included RCTs in adults (≥ 18 years) undergoing non-cardiac surgery under general anesthesia, comparing standard care plus two multimodal components versus one component, with postoperative opioid consumption measured and pain measured by numeric rating scale (NRS) or visual analog scale (VAS).

resultsTwenty-seven trials were included. Meta-analysis of 17 trials (24 comparisons) showed that a second multimodal component reduces 24-hour opioid consumption by 5.2 mg oral morphine equivalents (95% CI[-7.7, -2.7]; p < 0.01; I² = 99%). Nineteen trials (29 comparisons) reported reduced pain scores at 4 h postoperatively by -0.5 points (95% CI[-0.8, -0.2]; I² = 94%). However, heterogeneity was very high. Subgroup analyses did not reveal a superior multimodal component. Adverse events were generally comparable, with some reductions in postoperative nausea and vomiting. Data on long-term outcomes and quality of recovery were limited.

conclusionsAdding a second multimodal analgesic component may modestly improve acute postoperative pain control and may reduce opioid consumption. Further research is needed to determine optimal combinations for specific surgical settings, to systematically evaluate associated adverse effects and to assess long-term outcomes including chronic pain prevention.

Indexed as

Acute PainAnalgesicsPostoperative PainAnalgesics, OpioidHumansRandomized Controlled Trials as TopicAnalgesicsAnalgesics, OpioidClonidineDexamethasoneEvidence synthesisKetamineLidocaineMagnesiumMeta-analysisMultimodal analgesiaPostoperative painPregabaline

Identifiers

PMID41781853
PMCPMC13067472

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Registered trials

None linked

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.