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.
Patients ≥ 18 years old who undergo any procedure including surgical, therapeutic, or diagnostic requiring care by anesthesia providers.
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
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:
Any provider signed into the case between Anesthesia Start and Anesthesia End
OPIOID SPARING MEDICATION
PACU PAIN SCORE
|Date Reviewed||Reviewer||Institution||Summary||QC Vote|
|03/16/2023||Exclusion||Replaced Non-Operative phenotype with Intubation Only as exclusion|
|10/12/2022||Exclusion||Modified to use TEE/Cardioversion and Endoscopy|
|04/07/2022||Success||Modified local anesthetic to check 10516 (other-local infiltration medication)|
|03/21/2022||Success||Modified local medication bounds, Preop Start to Anesthesia End; Updated dose amount to include 1mL doses|
|01/04/2022||Multiple||Modified to exclude cases using new Cardiac phenotype; Exclude eye procedures (CPT 00145; Meloxicam added as non-opioid; Added local anesthetic routes (2006, 2024, 2034); Removed lidocaine documented in mg from medication list.|
|09/20/2021||Exclusion||Modified to use new ECT phenotype|
|06/01/2021||Success||Added Dexmedetomidine to medication list|