Examining Race-Based Disparities in Access to Multimodal Analgesia

Following major surgery, Black patients maty be less likely to receive multimodal analgesia options compared to white patients, according to research results presented at ANESTHESIOLOGY 2024, the annual meeting of the American Society of Anesthesiologists.

A previous body of research has demonstrated that multimodal analgesia, utilizing multiple types of pain medications to reduce and manage pain—is more effective when treating postoperative pain vs pain management with a single medication alone. This is especially true with complex surgeries.

Researchers from the Johns Hopkins University School of Public Health sought to investigate the association between race and postoperative pain management, in light of a body of research that has documented the racial disparities prevalent in health care delivery and outcomes, and linked racial and ethnic disparities with analgesia options provided to patients.

In a retrospective cohort analysis,¹ investigators reviewed electronic health record data from patients who underwent surgical procedures (high-risk non-cardiothoracic and abdominal surgeries) requiring ICU admission within the first 24 hours after surgery at Johns Hopkins Hospitals between 2016 and 202. The primary outcome was the use of 4 or more analgesic modes in the first 24 hours after surgery.

More than 32,000 surgical procedures were identified, with 482 African American patients who were propensity matched with 2460 white patients. Results of a univariate analysis showed that African Americans were significantly more likely to receive oral opioids (OR, 1.74; 95% CI, 1.34-2.25), and multivariate regressions showed that African American race was significantly associated with a lower likelihood of receiving 4-mode multimodal analgesia (aOR, 0.71; 95% CI, 0.514-0.968).

“We know that multimodal analgesia provides more effective pain management with less need for opioids, which are highly addictive. It should be standard practice, especially in high-risk surgical patients,” said Niloufar Masoudi, MD, MPH, anesthesiologist and research assistant at Johns Hopkins University, and lead study author, in a news release.²

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Although the “optimal number of drug combinations for multimodal analgesia” remains unknown, Masoudi continued, the use of 4 types of pain medication—rather than 2 or 3 types—may lead to effective pain control with fewer opioids used.

“Further research needs to be done to understand the specific cause for the differences in multimodal analgesia between Black and white patients so recommendations can be developed,” Masoudi added. “Additionally, research should be conducted in other ethnic groups to assess whether they are impacted by similar disparities.”

Until them, health care providers should keep these disparities in mind and develop standard protocols to ensure all patients receive multimodal analgesia when it is medically appropriate.

READ MORE: Nonopioid Pain Management Resource Center

References

1. Masoudi N, Faraday N. Differences in use of multimodal analgesia by race in surgical patients at high risk for cardiopulmonary complications. Presented at: ANESTHESIOLOGY 2024; October 18-22, 2024; Philadelphia, PA. Poster A1182.

2. Black patients less likely to receive multimodal pain management options after surgery. News release. American Society of Anesthesiologists. October 20, 2024. Accessed October 21, 2024. https://www.newswise.com/articles/black-patients-less-likely-to-receive-multimodal-pain-management-options-after-surgery