Study reveals racial bias in postsurgical analgesia

While recovering from major surgery, Black patients may be less likely to receive certain multimodal analgesia options and more likely to receive oral opioids than white patients, according to research being presented at the ANESTHESIOLOGY^® 2024 annual meeting.

Multimodal analgesia, which uses multiple types of pain medication to reduce pain, has been shown to be more effective at treating postsurgical pain than a single medication alone, particularly after complex surgeries such as lung or abdominal cancer surgery and hernia repair. Multimodal analgesia is used to improve pain control while reducing the side effects that may come with opioids.

In the retrospective study, Black patients were 29% less likely than white patients to receive multimodal anesthesia using a combination of four drugs. Additionally, while almost all patients received at least one dose of an opioid intravenously (IV), Black patients were 74% more likely than white patients to receive oral opioids in addition to IV opioids.

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. We strive to provide patients the most effective pain control while using fewer opioids. Although the optimal number of drug combinations for multimodal analgesia is unknown, using four different types of pain medication vs. two or three may better help to achieve this goal. However, more research is needed."

Niloufar Masoudi, M.D., MPH, lead author of the study, anesthesiologist and research assistant at Johns Hopkins University, Baltimore

The authors compared the postsurgical pain management received by 2,460 white patients and 482 Black patients in the intensive care unit for the first 24 hours after complex, high-risk surgeries that occurred between 2016 and 2021 at one institution. They defined multimodal analgesia as the receipt of an opioid plus at least one other form of pain medication, such as a local anesthetic (epidural or pain patch placed on the skin), nonsteroidal anti-inflammatory drug (NSAID), IV ketamine or oral gabapentin. The researchers ruled out other reasons for the difference they observed with reasonable confidence (e.g., insurance, health conditions, age, etc.).

Several factors may have contributed to the disparity, including differences in pain reported by the patient, patient preferences for or against a form of pain management and practitioner bias for or against forms of pain management by race, Dr. Masoudi said.

"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. Additionally, research should be conducted in other ethnic groups to assess whether they are impacted by similar disparities," said Dr. Masoudi. "In the meantime, pain specialists need to understand the benefits of multimodal analgesia, recognize the existence of disparities in its use and develop standardized protocols to ensure all patients receive this preferred form of pain management when medically appropriate."