Background and Objectives: The management of
acute postoperative pain (APP) following major abdominal surgery implies various analgetic strategies.
Opioids lie at the core of every
analgesia protocol, despite their side effect profile. To limit patients' exposure to
opioids, considerable effort has been made to define new
opioid-sparing
anesthesia techniques relying on multimodal
analgesia. Our study aims to investigate the role of adjuvant multimodal
analgesic agents, such as
ketamine,
lidocaine, and
epidural analgesia in perioperative
pain control, the incidence of
postoperative cognitive dysfunction (POCD), and the incidence of
postoperative nausea and vomiting (
PONV) after major abdominal surgery. Materials and Methods: This is a clinical, observational, randomized, monocentric study, in which 80 patients were enrolled and divided into three groups: Standard group, C (n = 32), where patients received perioperative
opioids combined with a fixed regimen of
metamizole/
acetaminophen for
pain control; co-analgetic group, Co-A (n = 26), where, in addition to standard
therapy, patients received perioperative systemic
ketamine and
lidocaine; and the epidural group, EA (n = 22), which included patients that received standard perioperative analgetic
therapy combined with
epidural analgesia. We considered the primary outcome, the
postoperative pain intensity, assessed by the visual analogue scale (VAS) at 1 h, 6 h, and 12 h postoperatively. The secondary outcomes were the total intraoperative
fentanyl dose, total postoperative
morphine dose, maximal intraoperative
sevoflurane concentration,
confusion assessment method for intensive care units score (CAM-ICU) at 1 h, 6 h, and 12 h postoperatively, and the postoperative dose of
ondansetron as a marker for
postoperative nausea and vomiting (
PONV) severity. Results: We observed a significant decrease in VAS score, as the primary outcome, for both multimodal
analgesic regimens, as compared to the control. Moreover, the intraoperative
fentanyl and postoperative
morphine doses were, consequently, reduced. The maximal
sevoflurane concentration and POCD were reduced by EA. No differences were observed between groups concerning
PONV severity. Conclusions: Multimodal
analgesia concepts should be individualized based on the patient's needs and consent. Efforts should be made to develop strategies that can aid in the reduction of
opioid use in a perioperative setting and improve the standard of care.