Results: Overall, 85.6% (N = 1,318,165) of patients received multimodal analgesia. In multivariable models, additions of analgesic modes were associated with stepwise positive effects: total hip arthroplasty patients receiving more than 2 modes (compared to “opioids only”) experienced 19% fewer respiratory (odds ratio, 0.81; 95% CI, 0.70 to 0.94; unadjusted 1.0% [N = 1,513] vs. 2.0% [N = 1,546]), 26% fewer gastrointestinal (odds ratio, 0.74; 95% CI, 0.65 to 0.84; unadjusted 1.5% [N = 2,234] vs. 2.5% [N = 1,984]) complications, up to a –18.5% decrease in opioid prescription (95% CI, –19.7% to –17.2%; 205 vs. 300 overall median oral morphine equivalents), and a –12.1% decrease (95% CI, –12.8% to –11.5%; 2 vs. 3 median days) in length of stay (all P < 0.05). Total knee arthroplasty analyses showed similar patterns. Nonsteroidal antiinflammatory drugs and cyclooxygenase-2 inhibitors seemed to be the most effective modalities used.
Conclusions: While the optimal multimodal regimen is still not known, the authors’ findings encourage the combined use of multiple modalities in perioperative analgesic protocols.
-
Multimodal analgesia is commonly used in joint replacement surgery with evidence of clinical effectiveness
-
Population-based data indicating the influence of the number of modalities on opioid prescribing, side effects, and cost, are more limited
-
Using a Premier Perspective database of total hip and knee arthroplasties, patients were grouped into “opioids only” and 1, 2, or more than 2 additional modalities
-
There was a stepwise modality number-associated decrease in opioid patient-controlled analgesia use, opioid prescriptions, and some opioid-related side effects, but not cost of hospitalization
-
The strongest association was for cyclooxygenase-2 inhibitors and nonsteroidal antiinflammatory drugs