Association of opioid-based and opioid-free multimodal analgesia with hospital length of stay and postoperative pain in outpatient aesthetic plastic surgery: a retrospective cohort study
Journal
JPRAS Open
ISSN
23525878
Date Issued
2026-11
Author(s)
Jarrín-Navarro, Stephanie
Type
Article
Abstract
Background: Outpatient aesthetic plastic surgery has expanded significantly, increasing the importance of effective perioperative pain management strategies. Multimodal analgesia is widely used to improve postoperative outcomes and reduce opioid exposure; however, evidence comparing opioid-based and opioid-free approaches in real-world ambulatory plastic surgery settings remains limited. Objective: To evaluate the association between opioid-based and opioid-free multimodal analgesia and postoperative pain and hospital length of stay in patients undergoing outpatient aesthetic plastic surgery under general anesthesia. Methods: A retrospective cohort study was conducted including 208 patients undergoing outpatient aesthetic plastic surgery between November 2022 and March 2024 in Quito, Ecuador. Patients were classified into opioid-free or opioid-based multimodal analgesia groups (n = 104 each) based on intraoperative anesthetic records. Primary outcomes included postoperative pain and hospital length of stay. Analyses included descriptive statistics, regression models, and stratification by surgical group to address procedural heterogeneity. Results: Baseline characteristics differed between groups, particularly in surgical procedure type, age, body mass index, and comorbidities. Opioid-based multimodal analgesia was associated with higher odds of moderate pain at operating room exit (OR 21.15, 95% CI 9.76–45.84) and at 15 min (OR 3.91, 95% CI 1.22–12.52), increased need for rescue analgesia (OR 2.57, 95% CI 1.20–5.49), and prolonged hospital length of stay (OR 5.42, 95% CI 2.36–12.45). These associations remained significant in multivariable models for most outcomes. Stratified analyses by surgical group showed consistent associations, although effect sizes varied according to procedure type. Conclusion: Multimodal analgesic strategy was associated with differences in postoperative pain and hospital length of stay in outpatient aesthetic plastic surgery. Opioid-based regimens were more frequently used in more extensive procedures and were associated with worse early postoperative outcomes, whereas opioid-free strategies were predominantly used in less invasive procedures. These findings highlight the importance of procedure-specific and patient-centered analgesic approaches. Due to the observational design and baseline heterogeneity, results should be interpreted as associative rather than causal. © 2026 The Author(s). Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. This is an open access article under the CC BY-NC-ND license. http://creativecommons.org/licenses/by-nc-nd/4.0/