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ORIGINAL RESEARCH article

Front. Med.

Sec. Intensive Care Medicine and Anesthesiology

Volume 12 - 2025 | doi: 10.3389/fmed.2025.1660365

Routes of Postoperative Analgesia Administration in Surgical Wards: Practice vs Guidelines and Economic Implications

Provisionally accepted
  • 1University Hospital Center Dr Dragiša Mišović, Belgrade, Serbia
  • 2Univerzitet u Beogradu Medicinski fakultet, Belgrade, Serbia
  • 3Univerzitetski klinicki centar Srbije, Belgrade, Serbia
  • 4Vojnomedicinska akademija, Belgrade, Serbia
  • 5Universitatsklinikum Jena, Jena, Germany
  • 6Inselspital Universitatsspital Bern, Bern, Switzerland

The final, formatted version of the article will be published soon.

Introduction: Multimodal analgesia, critical to postoperative recovery, typically involves oral (PO), intravenous (IV), or regional analgesia. The PO route is preferred for its non-invasive nature, cost-effectiveness, and comparable efficacy to parenteral routes. This study assessed whether analgesic practices in surgical wards align with current guidelines and evaluated the economic impact of deviations. Materials and methods: Data from 2,354 adult patients, collected using the PAIN OUT methodology across 10 Serbian hospitals, were analyzed. Patients undergoing various surgeries were observed during the first 24 hours postoperatively. We analyzed analgesic administration routes on surgical wards for the entire cohort and a subgroup where PO administration was deemed feasible. Potential savings of transitioning from parenteral to PO were calculated, including medication, disposables, and labor costs. Results: In the entire cohort, the IV route was used in 86% of patients receiving non-opioids and 39% receiving opioids, while the IM route was used in 7% and 4%, respectively. The PO route was employed in only 1% of patients. Among 1,850 patients for whom the PO route was considered feasible, the IV route was used in 86% for non-opioids and 38% for opioids, and the IM route in 8% and 5%, respectively. Transitioning from parenteral to PO administration would reduce costs from 822.3 RSD (7.84 USD) to 124.5 RSD (1.19 USD) per patient, resulting in 85% savings. Conclusion: The reliance on IV analgesia and underuse of PO route in Serbia reveals a gap between practice and guidelines. Transitioning to PO analgesia could result in significant cost savings.

Keywords: Analgesia, cost, intravenous, Oral route, postoperative, Route, Surgery

Received: 05 Jul 2025; Accepted: 20 Oct 2025.

Copyright: © 2025 Bojic, Ladjevic, Palibrk, Rancic, Bezmarevic, Meissner, Zaslansky, Stamer, Baumbach and Stamenkovic. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Suzana Bojic, subojic@yahoo.com

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