(140) The Effect of Multimodal Preoperative Pain Management on Post-Operative Anesthesia Care Unit Opioid Requirements in Laparoscopic Cholecystectomies

Abstract

Non-opioid medications as a part of multimodal analgesia have been increasingly suggested in the management of acute post-surgical pain. Multimodal protocols have been gaining attention worldwide and have shown to reduce the length of postoperative hospital stay without adversely affecting morbidity. By combining preoperative medications in a multimodal fashion we believe that we can maintain postoperative physiological function and accelerate recovery in patients undergoing routine surgeries such as the laparoscopic cholecystectomy. The present study was planned to compare the opioid consumptions between two groups, those who were pre-medicated with multimodal analgesia in the preoperative setting versus those who were not pre-medicated in the preoperative setting. We hypothesize that the application of a multimodal approach may even reduce or prevent the development of significant postoperative pain in patients undergoing elective laparoscopic cholecystectomy, thereby facilitating same-day surgery in this patient population. In this prospective study patients who met the inclusion criteria, were allocated into two groups: Group A patients received Tylenol 650mg, Pregabalin 75mg, and Oxycodone 10mg in the preoperative setting just prior to induction and Group B, no medication. All patients were assessed in the postoperative setting for both pain scores as well as opioid requirements throughout their PACU stay. Postoperatively, significantly more patients in the premedication group were without pain on arrival in the post-anesthesia care unit (PACU). There was a statistical difference observed between Group A (premedication group) vs. Group B (control, no premedication) in regard to PACU opioid requirements; Group A requested pain medication less frequently in the PACU. All in all, the concomitant use of acetaminophen, opioids, and neuropathic adjuvants such as pregabalin is an effective strategy to decrease postoperative opioid requirements, in turn reducing opioid-related adverse effects and ultimately leading to faster recovery and discharge.