Impact of multimodal analgesia using intravenous non-opioid agents on immediate postoperative rescue analgesic use following minor general surgery: a retrospective study

Background: Intraoperative multimodal analgesia with non-opioid agents is standard in perioperative pain management. However, evidence directly comparing triple, dual, and single agent regimens remains limited. Methods: This retrospective single-center study analyzed adult patients undergoing minor general surgery, setting in which opioids are not routinely employed for postoperative pain management. The primary outcome was the use of rescue analgesics within 4 hours after surgery, comparing triple (acetaminophen [AAP] + nonsteroidal anti-inflammatory drugs [NSAIDs] + nefopam), dual (AAP + NSAIDs, AAP + nefopam, or NSAIDs + nefopam), and single agent regimens. Comparisons among individual dual agent combinations and among individual single agents were performed as secondary analyses. Outcomes were estimated using multivariable regression with inverse probability of treatment weighting (IPTW). Results: < 0.001), with adjusted probabilities of 31.4% (triple), 49.1% (dual), and 67.2% (single). Among dual regimens, the lowest rescue probability was observed with NSAIDs + nefopam (39.7%), followed by AAP + NSAIDs (53.2%), and AAP + nefopam (58.7%). Conclusions: Triple agent intraoperative non-opioid analgesia was associated with the greatest reduction in postoperative rescue analgesic use, with a stepwise benefit observed across single, dual, and triple regimens. These findings support the active use of multimodal non-opioid analgesia in minor general surgery.