Multimodal Analgesia in Enhanced Recovery: Which Components Carry the Effect and Which Are Ritual
DOI:
https://doi.org/10.5281/zenodo.22549110Keywords:
Multimodal analgesia, Enhanced recovery after surgery, Opioid-sparing analgesia, Perioperative pain management, Regional anaesthesia, Postoperative painAbstract
Multimodal analgesia is a core pillar of Enhanced Recovery After Surgery pathways, combining
acetaminophen, non-steroidal anti-inflammatory drugs, gabapentinoids, regional and neuraxial
techniques, and opioid-minimising anaesthetic strategies with the shared aim of reducing opioid
consumption and its associated harms. Yet the component-level trial evidence supporting each individual
element varies substantially in both volume and effect size, and some components now embedded in
standard order sets carry comparatively thin randomised evidence relative to their routine adoption. This
review synthesises the component-level randomised trial and meta-analytic literature underlying
multimodal analgesia in enhanced recovery pathways, distinguishing components with strong, consistent
opioid-sparing evidence from those whose inclusion appears to rest more on pathway convention than on
component-specific trial support.
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