Multimodal analgesia strategies in patients at high risk of respiratory depression: a scoping review of the available evidence of studies published between 2015 and 2026.
DOI:
https://doi.org/10.71112/djhp9f80Keywords:
Trauma, NSAIDs, Block, Analgesia, PainAbstract
The available evidence demonstrates that multimodal analgesia represents a fundamental pillar in the management of acute pain, particularly in patients at high risk of opioid-induced respiratory depression. This approach, based on the combination of pharmacological interventions and regional techniques, consistently reduces opioid consumption, which constitutes the primary mechanism for decreasing the risk of adverse respiratory events.
The findings indicate that agents such as ketamine/esketamine, dexmedetomidine, and intravenous lidocaine, together with regional techniques (e.g., transversus abdominis plane block and epidural analgesia), not only improve pain control but also contribute to the preservation of respiratory function and reduction of postoperative complications. Additionally, continuous monitoring strategies and risk stratification tools such as the PRODIGY score enable early identification of high-risk patients, facilitating safer and more individualized management.
It was identified that the risk of respiratory depression is not uniform, being concentrated in vulnerable populations such as patients with obesity, obstructive sleep apnea, advanced age, chronic opioid use, and cardiovascular or respiratory comorbidities. In these groups, the implementation of multimodal analgesia becomes a priority, not only as a therapeutic strategy but also as a preventive intervention.
Although not all studies directly evaluated respiratory depression, there is a consistent association between reduced opioid consumption and a lower risk of respiratory events, reinforcing the concept of opioid-sparing strategies as a cornerstone of patient safety. However, methodological heterogeneity and variability in reported outcomes limit the ability to draw definitive causal conclusions.
Overall, multimodal analgesia emerges as an effective and safe strategy that not only optimizes pain control but also enhances respiratory safety and quality of care, representing a key approach in modern perioperative medicine.
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Copyright (c) 2026 Carina Alexandra Trujillo Saavedra, Sonia Carolina Arias Durán, Tania Dayanara Chanaluisa Cerda, Shirley Marisol Angamarca Jara, Sandra Del Rocio Morocho Imbacuan (Autor/a)
This work is licensed under a Creative Commons Attribution 4.0 International License.
