Health
Study reveals racial bias in postoperative pain relief
While recovering from major surgery, Black patients are less likely than white patients to receive certain multimodality pain relief options and more likely to receive oral opioids, according to a study published in ANESTHESIOLOGY there is a possibility® 2024 Annual Meeting.
Multimodal analgesia, which uses multiple types of analgesics to reduce pain, is particularly useful in the treatment of postoperative pain after complex surgeries such as lung cancer or abdominal cancer surgery or hernia repair. has been shown to be more effective than the drug alone. Multimodal analgesia is used to improve pain control while reducing the side effects that can be associated with opioids.
In a retrospective study, black patients were 29% less likely to receive multimodal anesthesia with a four-drug combination than white patients. Additionally, while nearly all patients received at least one intravenous (IV) dose of opioid, black patients were 74% more likely than white patients to receive oral opioids in addition to IV opioids.
We know that multimodal analgesia reduces the need for highly addictive opioids and provides more effective pain management. This should become standard practice, especially in high-risk surgical patients. We strive to provide our patients with the most effective pain management while reducing the use of opioids. The optimal number of drug combinations for multidisciplinary analgesia is unknown, but the use of four different analgesics rather than two or three may be more effective in achieving this goal. Possibly. However, further research is needed. ”
Niloufar Masoudi, MD, MPH, lead author of the study, anesthesiologist and research assistant at Johns Hopkins University in Baltimore
The authors found that 2,460 white patients and 482 black patients in the intensive care unit underwent surgery during the first 24 hours after complex, high-risk surgeries performed at one institution between 2016 and 2021. Postoperative pain management was compared. They use multimodal analgesia, such as local anesthetics (epidurals or pain patches placed on the skin), nonsteroidal anti-inflammatory drugs (NSAIDs), intravenous ketamine, or oral gabapentin, in addition to opioids. It was defined as receiving at least one other form of pain medication. . The researchers ruled out other reasons for the observed differences (such as insurance, health status, age, etc.) with reasonable confidence.
Dr. Masoudi said several factors may have contributed to this disparity, including differences in patient-reported pain, patient preferences for forms of pain management, and physician bias against forms of pain management based on race. said.
“Further research is needed to understand the specific causes of the diverse analgesic differences between black and white patients so that recommendations can be made. Additionally, similar disparities in other ethnic groups are needed.” Research needs to be conducted to assess whether it is affected by “Meanwhile, pain professionals understand the benefits of multimodal analgesia, recognize the existence of disparities in its use, and ensure that all patients receive this preferred form of pain management when medically appropriate.” We need to develop standardized protocols to ensure that
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