IMPACT OF MULTIMODAL ANALGESIA PROTOCOL ON CLINICAL OUTCOME IN CRITICALLY ILL PATIENTS IN AN INTENSIVE CARE UNIT: A PROSPECTIVE OBSERVATIONAL STUDY OVER A PERIOD OF 18 MONTHS IN SICU, SMHS HOSPITAL GMC SRINAGAR J and K.
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Keywords
multimodal analgesia, pain management, surgical ICU, opioids, clinical outcomes
Abstract
Background: Pain management in critically ill surgical patients is often challenging due to altered physiology, need for mechanical ventilation, and the risks associated with opioid use. Multimodal analgesia protocols have been increasingly recognized as effective strategies to reduce opioid dependence while maintaining adequate pain control. Aim: To evaluate the impact of a multimodal analgesia protocol on clinical outcomes in critically ill patients admitted to the Surgical Intensive Care Unit (SICU) of SMHS Hospital, Government Medical College Srinagar. Methods: This prospective observational study was conducted over 18 months and included 700 critically ill patients admitted to the SICU. Pain was assessed using Visual Analogue Scale (VAS) or Numerical Rating Scale (NRS) in communicative patients and Behavioral Pain Scale (BPS) in intubated patients. Analgesics were administered according to a protocol that utilized non-opioids, weak opioids, opioids, adjuvants, and regional blocks based on pain severity. Data were analyzed using SPSS version 23, with Mann–Whitney U and Spearman’s correlation tests applied where appropriate. Results: The mean age of the study population was 49.2±20.97 years, with a male predominance (64%). Most patients belonged to the general surgery department (25.1%), and exploratory laparotomy was the most common procedure (28.3%). Of the total, 42.9% were intubated and 57.1% extubated. The mean duration of mechanical ventilation was 76.6±61.87 hours, while the mean ICU stay was 5.4±4.43 days. Non-opioid analgesics, particularly paracetamol (66.5%), diclofenac (30%), and regional techniques (44%), were widely used. Opioid use was minimized, with morphine required only in 15% of intubated patients. The multimodal protocol was associated with effective pain control, reduced opioid requirements, and acceptable ICU outcomes. Conclusion: Implementation of a multimodal analgesia protocol in the SICU setting improved pain control while reducing opioid exposure, supporting its role in optimizing recovery and clinical outcomes in critically ill surgical patients. Wider adoption of such structured protocols may enhance perioperative care and resource utilization in intensive care units.
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Dr. Safeena Razak
Postgraduate Scholar, Department of Anaesthesiology and Critical Care, Government Medical College Srinagar, India
Dr. Rumaisa Ayoub
Postgraduate Scholar, Department of Anaesthesiology and Critical Care, Government Medical College Srinagar, India
Dr. Abdul Hakim
Professor, Department of Anaesthesiology and Critical Care, Government Medical College Srinagar, India
