Decreasing postoperative narcotics in reconstructive pelvic surgery: a randomized controlled trial

Reagan, Krista; O’Sullivan, David; Gannon, Richard; Steinberg, Adam C.

doi:10.1016/j.ajog.2017.05.041

Cited by 40 publications

(26 citation statements)

References 28 publications

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“…Such multimodal analgesia strategies were found to be efficacious in other postsurgical populations including orthopedic, gastric bypass, gynecologic, and cardiothoracic surgery. [12][13][14][15][16] In light of the evidence supporting multimodal analgesia use in other surgical populations and the risks of opioid use in liver transplant recipients, our institution sought to reduce postsurgical opioid use using a standardized multimodal analgesia strategy.…”

mentioning

confidence: 99%

Implementation of a Multimodal Pain Management Order Set Reduces Perioperative Opioid Use after Liver Transplantation

et al. 2019

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Study Objective Nonopioid strategies to optimize pain management in patients after liver transplantation remain underexplored. The purpose of this study was to evaluate whether the use of a multimodal pain management (MPM) order set would reduce postoperative opioid use in adult patients after liver transplantation. Design Retrospective pre– and post–order set implementation study. Setting Large academic tertiary care hospital. Patients Thirty‐one adults who underwent liver transplantation were included; of these, 18 received provider‐managed pain regimens (pre‐MPM group: August 20, 2016–January 17, 2018), and 13 received the MPM order set (post‐MPM group: January 18–July 31, 2018) after implementation of the order set on January 18, 2018. Measurements and Main Results The MPM order set included standardized receipt of acetaminophen 650 mg every 6 hours, gabapentin 300 mg every 8 hours (adjusted for renal function), and opioids for breakthrough pain. Patients managed with the MPM order set received, on average, 30.6 fewer opioid morphine milligram equivalents per day after final extubation than patients who did not receive MPM (median 16, interquartile range [IQR] 4.5–45.6 vs median 46.6, IQR 30.1–75.2; Mann‐Whitney U test, p=0.031). Although patients in the post‐MPM group had significantly worse renal function at baseline, no other statistically significant differences in baseline characteristics, pain scores, or prescribed outpatient opioids were noted between groups. Patients in the pre‐MPM group had a shorter intensive care unit and overall length of stay; however, patients in the post‐MPM group may have had more complex postoperative courses contributing to these differences. Conclusion Implementation of the MPM order set significantly reduced postoperative opioid use in liver transplant recipients. Our results provide a compelling rationale to further investigate the use of a non–opioid‐centered strategy to optimize pain management in patients recovering from liver transplantation, a population vulnerable to the risks of opioid use such as opioid use disorder, increased susceptibility to adverse effects, and poor allograft and survival outcomes.

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confidence: 99%

Implementation of a Multimodal Pain Management Order Set Reduces Perioperative Opioid Use after Liver Transplantation

et al. 2019

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“…Use of nonopioid analgesics (including ketorolac and gabapentin) has become common practice within enhanced recovery protocols and has been shown to decrease need for opioids in other reports. 11,[19][20][21][22] It is also possible that by being enrolled in a study in which they would need to report the number of opioids taken that patients in this study consumed fewer opioids, but only 3 percent reported wanting to take more opioids than they did.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Opioid Utilization and Patient Satisfaction in General Surgery Procedures: A Prospective Observational Study

Linnaus

Neville

Habermann

et al. 2021

The American Surgeon

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Background Wide variation of opioid prescribing persists despite attempts to quantify number of opioids utilized postoperatively. We aim to prospectively determine number of opioids used after common surgery procedures to guide future prescribing. Methods A prospective observational trial was performed of opioids prescribed and used postoperatively. Patients filled out pre- and postoperative surveys, and number of opioids utilized was captured at postoperative visit. Results One-hundred-and-thirteen patients met inclusion. Median opioids prescribed exceeded number of opioids taken for all procedures. Median number of opioids taken postoperatively was fewer than 10 for all categories of procedures: simple skin/soft tissue 2 (IQR 1-4), complex skin/soft tissue 1.5 (IQR 0-14), simple laparoscopy 1 (IQR 0-20) and complex laparoscopy 4 (IQR 0-20), laparotomy 0 (IQR 0-26), and open inguinal hernia 2 (IQR 0-2). Nearly 80% of patients had leftover opioids, and 31% planned to keep them. There was little difference between preoperative and postoperative level of satisfaction with a pain control regimen. Discussion Postoperatively, patients utilize opioids less frequently than prescribed and often keep leftover pills. Patient pain control satisfaction is unrelated to number of opioids prescribed and taken postoperatively.

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“…The use of multimodal analgesia in the postoperative setting has been shown to reduce overall opioid use and expedite recovery [12,[90][91][92] . Pain regimens consisting of multiple opioid-sparing analgesics, such as gabapentin, acetaminophen, and non-steroidal anti-inflammatory drugs (NSAIDs), have demonstrated synergistic effects and enable the reservation of opioids for breakthrough pain alone [13] .…”

Section: Pain Managementmentioning

confidence: 99%

Enhanced recovery and medical management after head and neck microvascular reconstruction

Gidumal¹,

Worrall²,

Phan³

et al. 2021

PAR

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Protocols to enhance and expedite recovery after surgery originally developed through efforts in gastrointestinal, colorectal, and thoracic surgery populations. Implementation of specific evidence-based interventions undertaken in the perioperative setting has been shown to decrease the length of stay, reduce cost, and improve patient outcomes and satisfaction. The basic tenets of enhanced recovery protocols are to reduce physiologic stress in the perioperative setting, improve nutritional status before and after surgery, promote respiratory and physical rehabilitation, and encourage frequent and recurring reassessment for quality improvement. Some interventions, such as the use of deep vein thrombosis prophylaxis in the perioperative setting, are now well established across surgical populations; however, the increased attention to these protocols has led to new innovative interventions in the head and neck population. This review highlights these innovative interventions designed to enhance recovery after major surgery, lends particular focus to the biological mechanisms behind these interventions, and describes their relevance to the head and neck population.

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Decreasing postoperative narcotics in reconstructive pelvic surgery: a randomized controlled trial

Cited by 40 publications

References 28 publications

Implementation of a Multimodal Pain Management Order Set Reduces Perioperative Opioid Use after Liver Transplantation

Implementation of a Multimodal Pain Management Order Set Reduces Perioperative Opioid Use after Liver Transplantation

Postoperative Opioid Utilization and Patient Satisfaction in General Surgery Procedures: A Prospective Observational Study

Enhanced recovery and medical management after head and neck microvascular reconstruction

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