Measure Abbreviation
PAIN-02
Measure Type
Informational
Description

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

Measure Time Period

Preop Start to Anesthesia End

Inclusions

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

Exclusions
  • Patients < 18 years of age
  • ASA 5 and 6
  • Cardiac Surgery (CPT: 00560, 00561, 00562, 00563, 00566, 00567, 00580)
  • Obstetric Procedures
  • Radiology Procedures
    • Anesthesia for non-invasive imaging or radiation therapy (CPT: 01922)
    • Has following MRI keywords in procedure text: MRI, MR Head, MR Brain, MR Chest, MR Torso, MR Abdomen, MR Lumbar, MR Spine, MR Knee, MR Femur, MR Abd, Offsite radiology procedure
    • Rooms tagged as: ‘Radiology - MRI’ or ‘Radiology - interventional radiology’
  • Non-operative procedure (CPT: 00104, 00124, 00520, 00532, 00635, 00731, 00732, 00740, 00810, 00811, 00812, 00813, 01990, 01991, 01992, 01999 )
  • Eye Procedures (CPT: 00103, 00140, 00142, 00144, 00147, 00148)
  • Patients who remained intubated postoperatively
Success

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

Other Measure Build Details

Local anesthetic is captured through medications documented with a route mapped to ‘Local infiltration’ or ‘intradermal’ with medication text including %caine%. Intraop notes mapped to ‘Misc - Local Infiltration of surgical site by surgical team’ are also considered.

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

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, Include.
Responsible Provider

NA

Threshold
90%
MPOG Concept IDs Required

 

MPOG Concept ID

Concept Description

ROUTE

2001

Intravenous

2008

Oral

2009

Nasal

2023

Enteric Tube

LOCAL ANESTHETIC

2007

Local Infiltration (route)

2027

Intradermal (must contain text ‘-caine’)

50626

Misc - Local Infiltration of surgical site by surgical team

ACETAMINOPHEN

10007

Acetaminophen

NSAIDS

10222

Ibuprofen

10747

Naproxen

10116

Celecoxib

KETOROLAC

10239

Ketorolac

KETAMINE

10238

Ketamine

10453

PROPOFOL W/ KETAMINE 10 MG/ML + 1 MG/ML

10572

PROPOFOL W/ KETAMINE 10MG/ML + UNSPECIFIED KETAMINE

10577

PROPOFOL W/ KETAMINE 10 MG/ML + 0.5 MG/ML

10578

PROPOFOL W/ KETAMINE 10 MG/ML + 1.5 MG/ML

10579

PROPOFOL W/ KETAMINE 10 MG/ML + 2 MG/ML

OTHER

10132

Clonidine

REGIONAL BLOCK

Value Code: 1-22

Peripheral Nerve Blocks

NEURAXIAL ANESTHESIA

Value Code: 1-6

Spinal, Epidural, and Caudal

PACU PAIN SCORE (information only)

3086

Pain Score (Generic)

3087

Pain Score (FLACC)

3088

Pain Score (Visual Analog Scale)

3089

Pain Score (Faces)

Rationale

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.

Risk Adjustment

NA

References
  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. Kharasch ED, David Clark J, Kheterpal S. Perioperative GabapentinoidsDeflating the Bubble. Anesthesiology. Published online June 26, 2020. doi:10.1097/ALN.0000000000003394
  3. Kharasch ED, David Clark J. Opioid-free Anesthesia: Time to Regain Our Balance. Anesthesiology. 2021;134(4):509-514. doi:10.1097/aln.0000000000003705