Multimodal analgesia in resource-limited settings: A comparative analysis of postoperative pain management strategies in Pakistan

Postoperative pain remains a critical yet often under-managed aspect of surgical recovery, influencing patient satisfaction, functional recovery, and quality of care. This study aimed to evaluate the comparative analysis of different postoperative pain management strategies and their impact on patient-reported outcomes in a tertiary care hospital in Pakistan. A cross-sectional analytical study was conducted among 431 surgical patients at a tertiary care facility. Data were collected on demographic variables, type of surgery, pain management strategy (monotherapy, opioid-based, multimodal, adjuvant), route of administration, analgesic frequency, patient satisfaction, side effects, and functional interference. Statistical analyses including chi-square tests, ANOVA, Pearson's correlations, were performed. A p-value < 0.05 was considered statistically significant. Multimodal therapy was the most used strategy (29.9%), followed by opioid-based (27.6%) and monotherapy (26.7%). Patient satisfaction was significantly associated with pain management strategy (p < 0.001), with 36.9% reporting satisfaction and 20.2% very satisfied. While multimodal therapy showed lower mean pain scores than opioid-based regimens, the difference between these two groups was marginally non-significant (p = 0.060), suggesting a trend but not definitive superiority in terms of pain reduction. However, multimodal therapy was significantly associated with earlier mobilization compared to opioid-based regimens (p < 0.001). Significant correlations were observed between type of pain management and both pain score (r = -0.177, p = 0.000) and mobilization time (r = -0.116, p = 0.016). Preoperative anxiety and depression were present in 29.9% of participants and significantly associated with pain perception (p = 0.005). Multimodal pain management significantly improves postoperative outcomes by reducing pain intensity and enhancing functional recovery. Implementing standardized multimodal analgesia protocols may optimize care quality in surgical patients.