INNOVATIONS in pharmacy

Transforming postoperative recovery: Synergistic impact of medication therapy management and precision analgesia on patient outcomes

Zaid Khan

Aditya Bangalore Institute of Pharmacy Education and Research (ABIPER)

https://orcid.org/0000-0002-8786-4033

Mekkanti Manasa Rekha

Aditya Bangalore Institute of Pharmacy Education and Research (ABIPER)

Sobha Rani Hiremath

Aditya Bangalore Institute of Pharmacy Education and Research (ABIPER)

Srihari R Shapur

Medax Hospitals (NABH Accredited)

DOI: https://doi.org/10.24926/iip.v16i4.6871

Keywords: medication adherence, postoperative pain, pain management, pain measurement, pharmacists, opioid analgesics

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Abstract

Background: Postoperative recovery is frequently compromised by poor medication adherence and suboptimal pain control, particularly in low- and middle-income countries (LMICs). This study evaluated the combined impact of structured Medication Therapy Management (MTM) and optimized analgesic regimens on postoperative outcomes.

Methods: A prospective interventional study was conducted at Medax Hospitals, Bengaluru, between June and August 2024. Ninety-five postoperative patients aged ≥18 years, undergoing multidisciplinary surgeries, receiving postoperative pain management, and with complete clinical records were enrolled. Patients unwilling to participate, undergoing emergency or non-surgical procedures, aged <18 years, or with psychological illness were excluded. Participants were randomized to receive either MTM (n = 48) or standard care (n = 47). MTM interventions included personalized medication reviews and patient counseling. Pain regimens comprised opioid-based (tramadol), steroidal, NSAID (Non-Steroidal Anti-Inflammatory Drug) combinations (diclofenac + paracetamol), or paracetamol monotherapy. Medication adherence was measured using the MARS-5 (Medication Adherence Report Scale), and pain intensity using the Numerical Rating Scale (NRS). Statistical analyses included chi-square tests, ordinal logistic regression, and mixed-effects modeling.

Results: MTM significantly improved adherence, with 100% of MTM recipients achieving moderate to high adherence versus 100% low adherence in controls (χ² = 95.0, p < 0.001). Ordinal logistic regression identified MTM as a strong predictor of adherence (OR >10¹³, p < 0.001). For pain management, tramadol yielded the lowest mean NRS score (0.78), outperforming steroids (2.00), diclofenac + paracetamol (3.68), and paracetamol alone (6.67) (p < 0.001). Mixed-effects models confirmed significant between-group differences (F = 99.54, p < 0.001).

Conclusion: Pharmacist-led MTM substantially enhanced postoperative medication adherence, while opioid-based regimens provided superior analgesia compared to non-opioid strategies. Integrating MTM with individualized analgesic protocols markedly improved surgical recovery, particularly in LMICs. Larger multicenter trials were warranted to validate these findings and explore scalable digital adherence solutions