Evaluation of Multimodal Analgesia in Reducing Postoperative Pain and Opioid Use after Major Abdominal Surgery

Open Access

Abstract

Background: Major abdominal surgery often causes significant postoperative pain, which is frequently undertreated in resource-limited settings like Bangladesh, where care remains largely opioid-centred. This study aimed to evaluate the impact of a standardized multimodal analgesia regimen compared with conventional opioid-centred postoperative analgesia on pain intensity and opioid consumption in major abdominal surgery. Methods & Materials: This prospective, randomized controlled trial was conducted from 01 August 2025 to 30 October 2025 in the Departments of Anaesthesia, Obstetrics and Gynaecology and General Surgery at Jamalpur Medical college Hospital and 250 Bedded General Hospital, Jamalpur, Bangladesh. Data were analyzed in SPSS using appropriate parametric or non-parametric tests and chi-square/Fisher’s exact tests, with p < 0.05 considered significant. Results: Among 80 patients (40 per group), baseline demographic, clinical, surgical, and anaesthetic characteristics were comparable between the multimodal and conventional groups. Despite this, intraoperative opioid use was significantly lower with multimodal analgesia (fentanyl 220 ± 60 vs 260 ± 70 µg, p = 0.01; morphine equivalents 10.5 ± 3.1 vs 13.8 ± 4.0 mg, p < 0.001). Postoperative pain scores were consistently reduced in the multimodal group by about 1 NRS point at rest (e.g., 3.8 vs 5.1 in PACU; 2.8 vs 3.8 at 24 hours; all p < 0.001) and 1.3–1.4 points on movement early after surgery, with benefits maintained up to 72 hours. Multimodal analgesia also resulted in fewer opioid-related adverse events, including nausea, vomiting, and excessive sedation, without an increase in serious complications. Conclusion: Multimodal analgesia significantly reduced postoperative pain and perioperative opioid requirements compared with conventional opioid-based regimens in patients undergoing major abdominal surgery, without increasing serious complications. It was also associated with fewer opioid-related adverse effects, including nausea, vomiting and excessive sedation.