Multiphasic Multimodal Analgesia for Postoperative Pain Management following Abdominal Surgeries: A Randomized Controlled Clinical Trial

Objectives: This study aims to evaluate a four-phasic MMA protocol vs the standard of care pain management in candidate patients for elective abdominal surgeries. Methods: The study was a randomized controlled clinical trial conducted at two tertiary hospitals in Iraq. One hundred thirty-two patients undergoing elective abdominal surgery were randomized 1:1 to intervention or control (standard of care). The intervention group received preoperative education and a combination of pharmacologic and non-pharmacologic interventions during the preoperative, intraoperative, postoperative, and discharge phases. The primary outcome was the area under the curve (AUC) of the VAS pain score-time over 72 hours. Secondary outcomes included opioid consumption, recovery milestones, functional recovery (QoR-15), patient satisfaction, and adverse events. Results: The intervention group demonstrated a significant reduction of pain AUC at 72 hours (median 162 vs 318, p < 0.001), opioid consumption (p < 0.001 at 24, 48, and 72 hours). The incidences of both constipation and nausea/vomiting were significantly lower in the intervention group. Postoperatively, both quality of recovery (QoR) and patient satisfaction demonstrated significant improvement in the intervention group compared to the controls (p < 0.001). Conclusion: Our structured four-phasic MMA protocol demonstrated superior efficacy and safety compared to opioid-based postoperative pain management in patients undergoing elective abdominal surgeries.