Intravenous multimodal analgesia for optimizing postoperative pain, opioidsparing, and recovery outcomes in surgical patients undergoing spinal anesthesia

Morwj Saleh Alsamkari; Abdurahman Talal Bahha; Ahmad Salah Sadaqa; Abdullah Alhashmi Alameer; Abdulghani Salah Sadaqa; Ghadi Aljuhani5; Anmar Faisal Mohammed Zabidi; Mamdouh Hussein Sulimani; Osama Khalid Galeb Al-ahdal

doi:10.24911/IJMDC.51-1762171882

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Online Published: 02 Dec 2025

IJMDC. 2025; 9(11): 2934-2946

doi: 10.24911/IJMDC.51-1762171882

Intravenous multimodal analgesia for optimizing postoperative pain, opioidsparing, and recovery outcomes in surgical patients undergoing spinal anesthesia

Morwj Saleh Alsamkari, Abdurahman Talal Bahha, Ahmad Salah Sadaqa, Abdullah Alhashmi Alameer, Abdulghani Salah Sadaqa, Ghadi Aljuhani5, Anmar Faisal Mohammed Zabidi, Mamdouh Hussein Sulimani, Osama Khalid Galeb Al-ahdal.

Abstract
Single shot spinal anesthesia is common in obstetric, orthopedic, urologic, and gynecologic surgery, but early postoperative pain and variable block regression hinder recovery. Intravenous (IV) perioperative adjuncts enhance block characteristics and reduce analgesic needs. We aimed to synthesize studies on the analgesic benefits, block effects, and safety of IV adjuncts administered around spinal anesthesia. We conducted this study according to Preferred Reporting Items for Systematic Reviews and Meta Analyses Guidance, electronic databases and reference lists were searched. Studies with adults undergoing surgery with single-shot spinal anesthesia were eligible. Records identified: 1287, included in qualitative synthesis, 48 studies in obstetric and non-obstetric settings. Multiple agents improved early analgesia and delayed the first rescue relative to control. IV dexamethasone and IV dexmedetomidine prolonged sensory block and reduced early analgesic needs; dexmedetomidine was associated with manageable bradycardia and sedation. Magnesium infusions prolonged two-segment regression and reduced opioid use without symptomatic toxicity under monitoring. IV acetaminophen showed mixed results, and IV lidocaine showed context-dependent effects on pain trajectories and recovery outcomes. When integrated into multimodal pathways, selected IV adjuncts administered with spinal anesthesia improve early postoperative analgesia and block characteristics, with agent-specific safety trade-offs.

Key words: Spinal anesthesia, intravenous adjuncts, dexamethasone, dexmedetomidine, magnesium sulfate, ketamine, acetaminophen, lidocaine, postoperative analgesia, PRISMA.

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Pubmed Style

Alsamkari MS, Bahha AT, Sadaqa AS, Alameer AA, Sadaqa AS, Aljuhani G, Zabidi AFM, Sulimani MH, Al-ahdal OKG. Intravenous multimodal analgesia for optimizing postoperative pain, opioidsparing, and recovery outcomes in surgical patients undergoing spinal anesthesia. IJMDC. 2025; 9(11): 2934-2946. doi:10.24911/IJMDC.51-1762171882

Web Style

Alsamkari MS, Bahha AT, Sadaqa AS, Alameer AA, Sadaqa AS, Aljuhani G, Zabidi AFM, Sulimani MH, Al-ahdal OKG. Intravenous multimodal analgesia for optimizing postoperative pain, opioidsparing, and recovery outcomes in surgical patients undergoing spinal anesthesia. https://www.ijmdc.com/?mno=294306 [Access: June 22, 2026]. doi:10.24911/IJMDC.51-1762171882

AMA (American Medical Association) Style

Alsamkari MS, Bahha AT, Sadaqa AS, Alameer AA, Sadaqa AS, Aljuhani G, Zabidi AFM, Sulimani MH, Al-ahdal OKG. Intravenous multimodal analgesia for optimizing postoperative pain, opioidsparing, and recovery outcomes in surgical patients undergoing spinal anesthesia. IJMDC. 2025; 9(11): 2934-2946. doi:10.24911/IJMDC.51-1762171882

Vancouver/ICMJE Style

Alsamkari MS, Bahha AT, Sadaqa AS, Alameer AA, Sadaqa AS, Aljuhani G, Zabidi AFM, Sulimani MH, Al-ahdal OKG. Intravenous multimodal analgesia for optimizing postoperative pain, opioidsparing, and recovery outcomes in surgical patients undergoing spinal anesthesia. IJMDC. (2025), [cited June 22, 2026]; 9(11): 2934-2946. doi:10.24911/IJMDC.51-1762171882

Harvard Style

Alsamkari, M. S., Bahha, . A. T., Sadaqa, . A. S., Alameer, . A. A., Sadaqa, . A. S., Aljuhani, . G., Zabidi, . A. F. M., Sulimani, . M. H. & Al-ahdal, . O. K. G. (2025) Intravenous multimodal analgesia for optimizing postoperative pain, opioidsparing, and recovery outcomes in surgical patients undergoing spinal anesthesia. IJMDC, 9 (11), 2934-2946. doi:10.24911/IJMDC.51-1762171882

Turabian Style

Alsamkari, Morwj Saleh, Abdurahman Talal Bahha, Ahmad Salah Sadaqa, Abdullah Alhashmi Alameer, Abdulghani Salah Sadaqa, Ghadi Aljuhani, Anmar Faisal Mohammed Zabidi, Mamdouh Hussein Sulimani, and Osama Khalid Galeb Al-ahdal. 2025. Intravenous multimodal analgesia for optimizing postoperative pain, opioidsparing, and recovery outcomes in surgical patients undergoing spinal anesthesia. International Journal of Medicine in Developing Countries, 9 (11), 2934-2946. doi:10.24911/IJMDC.51-1762171882

Chicago Style

Alsamkari, Morwj Saleh, Abdurahman Talal Bahha, Ahmad Salah Sadaqa, Abdullah Alhashmi Alameer, Abdulghani Salah Sadaqa, Ghadi Aljuhani, Anmar Faisal Mohammed Zabidi, Mamdouh Hussein Sulimani, and Osama Khalid Galeb Al-ahdal. "Intravenous multimodal analgesia for optimizing postoperative pain, opioidsparing, and recovery outcomes in surgical patients undergoing spinal anesthesia." International Journal of Medicine in Developing Countries 9 (2025), 2934-2946. doi:10.24911/IJMDC.51-1762171882

MLA (The Modern Language Association) Style

Alsamkari, Morwj Saleh, Abdurahman Talal Bahha, Ahmad Salah Sadaqa, Abdullah Alhashmi Alameer, Abdulghani Salah Sadaqa, Ghadi Aljuhani, Anmar Faisal Mohammed Zabidi, Mamdouh Hussein Sulimani, and Osama Khalid Galeb Al-ahdal. "Intravenous multimodal analgesia for optimizing postoperative pain, opioidsparing, and recovery outcomes in surgical patients undergoing spinal anesthesia." International Journal of Medicine in Developing Countries 9.11 (2025), 2934-2946. Print. doi:10.24911/IJMDC.51-1762171882

APA (American Psychological Association) Style

Alsamkari, M. S., Bahha, . A. T., Sadaqa, . A. S., Alameer, . A. A., Sadaqa, . A. S., Aljuhani, . G., Zabidi, . A. F. M., Sulimani, . M. H. & Al-ahdal, . O. K. G. (2025) Intravenous multimodal analgesia for optimizing postoperative pain, opioidsparing, and recovery outcomes in surgical patients undergoing spinal anesthesia. International Journal of Medicine in Developing Countries, 9 (11), 2934-2946. doi:10.24911/IJMDC.51-1762171882

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