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79th PostGraduate Assembly in Anesthesiology 2025
December 12 - 15, 2025 | New York City
3092
The effect of perioperative multimodal adjunct analgesics on postoperative pulmonary complications and opioid requirements: A retrospective cohort study
Poster Presenter
Part of Topic
Pain Medicine
BACKGROUND
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Postoperative pain is a strong predictor of patient dissatisfaction, has been linked to prolongedhospitalization and higher risks of postoperative pulmonary complications (PPC) [1]
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Multimodal adjunct analgesics (MAA) target various nociceptive pathways, reducing opioid use,possibly lowering PPC risk [2,3]
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HYPOTHESIS
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The use of perioperative MAA is associated with a lower risk of PPC, possibly mediated by lowerperioperative opioid requirements.
SETTING AND STUDY POPULATION
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62,265 adults undergoing non-ambulatory, non-emergent, non-cardiac surgery under general anesthesia with PACU admission (2014–2024, Beth Israel Deaconess Medical Center, Boston, Figure 1)
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EXPOSURE
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MAA defined as ≥2 non-opioid analgesics given perioperatively in preoperative holding area or operating room
OUTCOMES
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Primary: PPC; composite of reintubation, emergency non-invasive ventilation and pneumonia ≤7 days
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Secondary: opioid requirements intraoperatively and in PACU (presented in oral morphine equivalents OME) and postextubation desaturation
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STATISTICAL ANALYSIS
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Multivariable logistic and zero-inflated negative binomial regression, adjusted for patient, procedural, and anesthetic factors (Table 1)
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No overall risk reduction of PPC (ORadj 0.98; 95%CI 0.88-1.11, p=0.79, Figure 2)
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Reduced requirements of perioperative opioids (excluding remifentanil, Figure 2)
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Benefits were especially pronounced in younger and healthier patients as well aslonger and more complex procedures (Table 2)
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Lower risk of postextubation desaturation (n= 46,061, ORadj 0.82; 95%CI 0.75 -0.90; p< 0.001)