Study reveals racial disparities in pain management after surgery

Black patients recovering from major surgery are less likely to receive multimodal analgesia, a pain management approach shown to reduce opioid dependence, according to new research presented at the ANESTHESIOLOGY 2024 annual meeting in Philadelphia.

The study reveals that black patients are 29 percent less likely than their white counterparts to receive multimodal analgesia, which uses multiple medications to improve pain control while reducing opioid use. Experts noted that this approach has been particularly effective after complex surgeries, such as lung or abdominal cancer procedures and hernia repairs.

In addition to this disparity, the research found that black patients were 74% more likely to receive oral opioids in combination with intravenous (IV) opioids compared to white patients, despite the known risks of opioid addiction .

“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 Dr. Niloufar Masoudi, lead author of the study and an anesthesiologist at Johns Hopkins University.

The study examined the pain management of 2,460 white patients and 482 black patients during the first 24 hours after high-risk surgeries between 2016 and 2021. The researchers ruled out variables such as insurance, health conditions and age, identifying significant racial disparities in pain management. . Although most patients received IV opioids, black patients were significantly more likely to receive additional oral opioids.

Dr. Masoudi emphasized that causes of these disparities could include patient preferences, differences in reported pain, or physician bias. He called for more research to uncover the exact reasons and more studies on other ethnic groups to determine whether they face similar problems.

“Pain specialists must understand the benefits of multimodal analgesia, recognize the existence of disparities in its use, and develop standardized protocols to ensure that all patients receive this preferred form of pain management when medically appropriate.” , Masoudi said.

During the five-day conference, experts also discussed the critical topic of medication errors in perioperative settings.

Dr. Elizabeth Rebello of the Anderson Cancer Center highlighted distractions, inadequate training and fatigue as major contributors to these mistakes. He noted that communication and teamwork, combined with smart pumps and barcode technology, can help reduce errors.

“Implementing non-punitive information systems and fostering a culture of safety are key to preventing medication errors,” said Rebello.

As the medical community continues to address these disparities and challenges, Dr. Masoudi emphasized, “We must do more to ensure equitable treatment for all patients. Every patient deserves the highest level of care, regardless of race.”