Percentage of patients ≥ 18 years old who undergo a surgical or therapeutic procedure and receive a non-opioid adjunct preoperatively and/or intraoperatively.

Effective pain management during the perioperative time frame can decrease postoperative pain, improve patient outcomes after surgery. Opioids hold a prominent role in acute pain management yet carry significant risk of perioperative complications including postoperative nausea and vomiting (PONV), respiratory depression, and increased recovery time after surgery. The American Society of Anesthesiologists (ASA) has published guidelines and recommendations which endorse the routine use of multimodal analgesia whenever possible. Current evidence supports the use of opioid sparing analgesics in adult surgical populations that act through different mechanisms. This list includes (but is not limited to) acetaminophen, NSAIDs, ketamine, and clonidine. There is a lack of clear evidence on using Lidocaine infusion as an opioid sparing anagesic.

Preop Start to Anesthesia End

Patients ≥ 18 years old who undergo any procedure including surgical, therapeutic, or diagnostic requiring care by anesthesia providers.

• Patients < 18 years of age
• ASA 5 and 6
• Open Cardiac procedures as determined by Procedure Type: Cardiac Surgery 
• TEE/Cardioversions
• Endoscopy Procedures
• Bronchoscopy
• Obstetric Procedures
• Radiology Procedures
• Procedure Type: ECT
• Intubation Only cases 
• Otoscopy (00124)
• Central Line Placement (00532)
• Lumbar Puncture (00635)
• Other (01990, 01991, 01992, 01999)
  • Rooms tagged as ‘Other - offsite anesthesia’
  • Cases with procedure text ‘ABR Testing’ (without any additional procedures listed)
• Eye Procedures (CPT: 00103, 00140, 00142, 00144, 00145, 00147, 00148)
• Patients who remained intubated postoperatively

At least one non-opioid adjunct (medication, regional block, neuraxial block, or local injection) was administered to the patient during the measure time period.

Dexamethasone given alone is not considered a non-opioid adjunct to prevent multiple false positives that may skew measure performance.

Opioid Sparing Medications must be administered between Preop Start and Anesthesia End via a valid route (see MPOG route concepts listed above). Lidocaine given IV is not considered.

Local Anesthetic Considerations: Documentation must occur between Preop Start and Anesthesia End 

• Captured through administration of medications with text including ‘-caine’ via medication routes NOT including
  • 2001  Intravenous 
  • 2034  Laryngotracheal
  • 2006  Inhalational
  • 2024  Endotracheal 
• Volumes of < 1mL are not considered.
• Intraop notes mapped to ‘Misc - Local Infiltration of surgical site by surgical team’ (ID:50626) are also considered. 

Regional/Neuraxial Block is determined by the Peripheral Nerve Block and Neuraxial phenotypes respectively. Documentation considered from Preop Start through PACU End. See specifications for more details

Algorithm for determining patients who remained intubated postoperatively:

1. Was the patient transported to PACU? If Yes, Include.  If No, then 
2. Was extubation time prior to Anesthesia End? If Yes, Include. If No or missing, then,
3. Was MPOG concept 50380 ‘Emergence - ETT in place, patient manually ventilated’ documented between procedure end and anesthesia end? If Yes, exclude. If no, then,
4. Were sedation medication infusions continued after Anesthesia End? If Yes, exclude. If no, then include

NA

Any provider signed into the case between Anesthesia Start and Anesthesia End 

1. American Society of Anesthesiologists Task Force on Acute Pain Management. Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology. 2012;116(2):248-273.
2. Beloeil H, Garot M, Lebuffe G, et al. Balanced Opioid-free Anesthesia with Dexmedetomidine versus Balanced Anesthesia with Remifentanil for Major or Intermediate Noncardiac Surgery. Anesthesiology. 2021;134(4):541-551.
3. Dunn LK, Durieux ME. Perioperative Use of Intravenous Lidocaine. Anesthesiology. 2017;126(4):729-737.
4. Kharasch ED, David Clark J, Kheterpal S. Perioperative GabapentinoidsDeflating the Bubble. Anesthesiology. Published online June 26, 2020. doi:10.1097/ALN.0000000000003394
5. Kharasch ED, David Clark J. Opioid-free Anesthesia: Time to Regain Our Balance. Anesthesiology. 2021;134(4):509-514. doi:10.1097/aln.0000000000003705
6. Weibel S, Jelting Y, Pace NL, et al. Continuous intravenous perioperative lidocaine infusion for postoperative pain and recovery in adults. Cochrane Database Syst Rev. 2018;6:CD009642.