Comparing cost and effectiveness of IVPCA morphine with perioperative multimodal analgesia of oral etoricoxib and oxycontin: A retrospective study()

INTRODUCTION: Good pain control modality for post total knee replacement promotes patient's comfort and facilitates functional recovery, which may prevent post-operative complications; and shorten hospital stay. Therefore, manage pain efficiently and effectively have financial implications to the hospital. This retrospective study analyzed the clinical outcomes and costs of the intravenous (IV) patient-controlled analgesia (PCA) with a new perioperative multimodal analgesia (PMA) of using etoricoxib and oxycontin. METHODS: This retrospective study analyzed a total of 102 inpatients, 53 received both IVPCA and regular oral analgesics from September 2016 to February 2017, while 49 received preemptive oral etoricoxib before surgery and duly together with oxycontin and paracetamol after surgery from September 2017 to February 2018. Pain scores as the primary outcome were measured by Numeric Rating Scale (0–10) at rest (NRS-R) and on movement (NRS-M). They were analyzed by one-way analysis of covariance (ANCOVA). Other outcomes included side effects from analgesics, range of motion (ROM(o)), patient satisfaction, length of hospital stay and costs of medications. RESULTS: Patients in PMA group achieved better outcomes than PCA group. NRS-M of PMA group shown lower mean pain score and (standard error) than PCA group (2.96 [0.31] vs 4.26 [0.29]; p = 0.003), side effects from analgesics (18% vs 45%), ROM≥ 90° (55.1% vs 30.2%), patient satisfaction (8.97 vs 7.5 out of 10; p = 0.005), and length of hospital stay (6 days vs 8 days; p < 0.001). Moreover, the medication cost of PMA was 59.9% lower than PCA regimen. CONCLUSIONS: This PMA approach achieved better outcomes and saved hospital costs.