What is Mixed Martial Arts (MMA)?

From the Guidelines

MMA, or Multimodal Analgesic Approach, is a crucial part of managing acute pain in elderly and frail patients, and I strongly recommend its implementation to decrease opioid exposure and enhance recovery after surgical procedures and trauma. The multimodal analgesic approach (MMA) or “balanced analgesia” was introduced with the aim of decreasing the exposure to opioids, to address acute pain effectively, and enhance recovery after surgical procedure and trauma 1. This approach provides the use of multiple strategies including systemic analgesics, regional analgesic techniques, and non-pharmacological interventions to affect peripheral and/or central nervous system sites in the pain pathway with the main aim of achieving a synergistic effect of the various classes of drugs used at lower analgesic doses.

Key Components of MMA

• Analgesics, including opioids, nonopioid analgesics (such as acetaminophen and NSAIDs), the gabapentinoids (gabapentin and pregabalin), serotonin norepinephrine reuptake inhibitors, tricyclic antidepressants, and N-methyl-d-aspartate (NMDA) receptor antagonists
• Neuraxial (epidural and intrathecal) analgesia
• Peripheral nerve blocks
• Intra-articular and wound infiltration with local anaesthetics

Benefits of MMA

• Reduces opioid exposure
• Enhances recovery after surgical procedures and trauma
• Effective analgesia at lower opioid dosing
• Reduces related risk and produces fewer adverse effects
• Useful and safe for elderly patients

Implementation of MMA

• Should be individualized in a multidisciplinary approach according to the patient; type of pain; mechanism of pain (inflammatory or neuropathic); type of surgical procedure; location of pain; expected duration of pain
• Administering non-opioid analgesics (e.g., paracetamol and NSAIDs) on a scheduled basis, rather than as needed, to mitigate the fluctuations between peak and trough serum levels
• Consider age when determining opioid dosing for post-traumatic pain, with a 20 to 25% dose reduction per decade after age 55 may reduce opioid exposure without altering pain control 1

Regional Analgesia

• Peripheral nerve blocks (PNBs) are a crucial part of MMA, and I strongly recommend their implementation to decrease opioid exposure and enhance recovery after surgical procedures and trauma. Strong evidence confirms that the implementation of PNBs in managing acute pain associated with traumatic fractures in elderly patients is effective in decreasing the use of opioids, pain, and length of hospital stay 1.
• Neuraxial anesthesia involves local administration of an anesthetic or opioid into the spinal cord’s neuraxial (epidural or intrathecal) space, and is a useful option for adequate pain relief in hip fractures 1.

From the Research

MMA Overview

• There is no direct information available regarding MMA in the provided studies.
• The studies focus on various medical topics, including antibiotic treatment, sepsis prediction, and decision-making processes.
• None of the studies mention MMA explicitly.

Related Medical Topics

• Antibiotic treatment: A study published in 2 compares the effectiveness of cephalexin twice daily versus four times daily for treating urinary tract infections.
• Sepsis prediction: Research published in 3 explores the use of machine learning models to predict sepsis treatment decisions in pediatric emergency departments.
• Decision-making: A study in 4 discusses the importance of context in decision-making processes, highlighting the limitations of retrospective investigations.

Available Research

• The provided studies offer insights into various medical topics, but none directly address MMA.
• Further research would be necessary to provide information on MMA, as the current studies do not cover this topic.