Black patients may be more likely to be given oral opioids and less likely to be given certain multimodal analgesia options than white patients, according to research published by the American Society of Anesthesiologists on Oct. 20.
1. The authors of the retrospective study compared the postsurgical pain management given to 2,460 white patients and 482 Black patients in intensive care during the first 24 hours after "complex, high-risk surgeries" between 2016 and 2021 at a single institution, according to a news release from the organization.
2. The study defined multimodal analgesia as the receipt of an opioid plus at least one other form of pain management, including local anesthesia, nonsteroidal anti-inflammatory drugs, IV ketamine or oral gabapentin. Reasons for the difference in treatment were ruled out with "reasonable confidence," such as insurance, health conditions or age.
3. Black patients were 29% less likely than white patients to receive multimodal analgesia using a combination of four drugs. Almost all white patients received at least one dose of an opioid intravenously, while Black patients were 74% more likely to receive oral opioids in addition to IV opioids.
4. "We know that multimodal analgesia provides more effective pain management with less need for opioids, which are highly addictive. It should be standard practice, especially in high-risk surgical patients," Niloufar Masoudi, MD, the lead author of the study and an anesthesiologist at Johns Hopkins University in Baltimore, said in the release.
5. Dr. Masoudi said several factors may have contributed to the disparity, including differences in pain reported by patients, patient preferences for or against different forms of pain management, or racial bias on the part of the provider.
6. Dr. Masoudi also said further research must be conducted to understand the specific causes of the racial disparities found in the study and that the research should be expanded to investigate the possibility of similar disparities in other ethnic groups.