Inpatient Opioid Use After Pancreatectomy: Opportunities for Reducing Initial Opioid Exposure in Cancer Surgery Patients

Newhook, Timothy E.; Dewhurst, Whitney L.; Vreeland, Timothy J.; Wang, Xuemei; Soliz, José; Speer, B. Bryce; Hancher-Hodges, Shannon; Feng, Chun; Bruno, Morgan L.; Kim, Michael P.; Aloia, Thomas A.; Vauthey, Jean Nicolas; Lee, Jeffrey E.; Katz, Matthew H.; Tzeng, Ching Wei D.

doi:10.1245/s10434-019-07528-z

Cited by 17 publications

(17 citation statements)

References 34 publications

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“…No significant difference was found in OT, POPF, DGE, LOS, significant morbidity, mortality or opioid use. On the contrary, a study by Newhook et al [ 12 ] found EDA resulted in lower opioid requirements compared to TAWC, however the pain scores in the postoperative period were similar between the analgesic modalities and failure rate was higher with EDA when compared to TAWC. Furthermore, on POD3 there was tendency trend for increased need for vasopressors after EDA with a higher proportion of patients with a postoperative rise in creatinine compared to baseline.…”

Section: Discussionmentioning

confidence: 92%

“…Although a variety of pain modalities have been explored for the management of postoperative pain after pancreatic surgery, the literature is generally limited to pair-wise comparisons, small study sizes and heterogeneity in their study population [2,5,8,9,[11][12][13][14][15][16][17][18][19][20][21][22][23] making it difficult to justify routine use of one pain modality over the other. This is reflected in the recently published ERAS guidance [6] which recommends EDA for postoperative pain relief and TAWC as an alternative, however the majority of evidence for this recommendation was extrapolated from non-pancreatic surgery.…”

Section: Introductionmentioning

confidence: 99%

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Postoperative Pain Relief after Pancreatic Resection: Systematic Review and Meta‐Analysis of Analgesic Modalities

et al. 2021

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Background This systematic review explored the efficacy of different pain relief modalities used in the management of postoperative pain following pancreatoduodenectomy (PD) and distal pancreatectomy (DP) and impact on perioperative outcomes. Methods MEDLINE (OVID), Embase, Pubmed, Web of Science and CENTRAL databases were searched using PRISMA framework. Primary outcomes included pain on postoperative day 2 and 4 and respiratory morbidity. Secondary outcomes included operation time, bile leak, delayed gastric emptying, postoperative pancreatic fistula, length of stay, and opioid use. Results Five randomized controlled trials and seven retrospective cohort studies (1313 patients) were included in the systematic review. Studies compared epidural analgesia (EDA) (n = 845), patient controlled analgesia (PCA) (n = 425) and transabdominal wound catheters (TAWC) (n = 43). EDA versus PCA following PD was compared in eight studies (1004 patients) in the quantitative meta-analysis. Pain scores on day 2 (p = 0.19) and 4 (p = 0.18) and respiratory morbidity (p = 0.42) were comparable between EDA and PCA. Operative times, bile leak, delayed gastric emptying, pancreatic fistula, opioid use, and length of stay also were comparable between EDA and PCA. Pain scores and perioperative outcomes were comparable between EDA and PCA following DP and EDA and TAWC following PD. Conclusions EDA, PCA and TAWC are the most frequently used analgesic modalities in pancreatic surgery. Pain relief and other perioperative outcomes are comparable between them. Further larger randomized controlled trials are warranted to explore the relative merits of each analgesic modality on postoperative outcomes with emphasis on postoperative complications.

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Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Postoperative Pain Relief after Pancreatic Resection: Systematic Review and Meta‐Analysis of Analgesic Modalities

et al. 2021

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“…A small study of 158 patients at a single institution noted significant variation in inpatient opioid consumption following pancreatectomy. 12 In this study, Newhook et al reported that among individuals undergoing a pancreatectomy, total oral morphine equivalents (OME) consumed ranged from 0 mg to 4,362 mg. The topic of inpatient opioid utilization following hepatopancreatic surgery has, however, not been wellstudied.…”

Section: Introductionmentioning

confidence: 83%

Wide variation in inpatient opioid utilization following hepatopancreatic surgery

Paredes

Hyer

Tsilimigras

et al. 2021

HPB

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“…APP, advance practice provider; MD, physician an outpatient operation is that there is no opportunity to wean off opioids as is possible following inpatient operations with 1-week lengths of stay. 14 Therefore, the need to maximize non-opioid bundles is paramount to reducing and even omitting discharge opioids.…”

Section: Discussionmentioning

confidence: 99%

“…After collection of individual opioid doses, amounts were converted to oral morphine equivalents (OME) using accepted conversion ratios as previously described. 14…”

Section: Data Source and Study Populationmentioning

confidence: 99%

Utilization and evolving prescribing practice of opioid and non‐opioid analgesics in patients undergoing lymphadenectomy for cutaneous malignancy

Witt

Cope

Chiang

et al. 2021

Journal of Surgical Oncology

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Background and Objectives: Opioids are commonly prescribed following surgery and can lead to persistent opioid use. We assessed changes in prescribing practices following an opioid education initiative for patients undergoing lymphadenectomy for cutaneous malignancy.Methods: A single-institution retrospective study of all eligible patients (3/2016-3/ 2020) was performed.Results: Indications for lymphadenectomy in 328 patients were metastatic melanoma (84%), squamous cell carcinoma (10%), and Merkel cell carcinoma (5%).At discharge, non-opioid analgesics were increasingly utilized over the 4-year study period, with dramatic increases after education initiatives (32%, 42%, 59%, and 79% of pts, respectively each year; p < 0.001). Median oral morphine equivalents (OMEs) prescribed also decreased dramatically starting in year 3 (250, 238, 150, and 100 mg, respectively; p < 0.001). Patients discharged with 200 mg OMEs were less likely to also be discharged with non-opioid analgesics (40% vs. 64%. respectively, p < 0.001).Conclusions: Analgesic prescribing practices following lymphadenectomy for cutaneous malignancy improved significantly over a 4-year period, with use of nonopioids more than doubling and a 60% reduction in median OME. Opportunities exist to further increase non-opioid use and decrease opioid dissemination after lymphadenectomy for cutaneous malignancy.

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Inpatient Opioid Use After Pancreatectomy: Opportunities for Reducing Initial Opioid Exposure in Cancer Surgery Patients

Cited by 17 publications

References 34 publications

Postoperative Pain Relief after Pancreatic Resection: Systematic Review and Meta‐Analysis of Analgesic Modalities

Postoperative Pain Relief after Pancreatic Resection: Systematic Review and Meta‐Analysis of Analgesic Modalities

Wide variation in inpatient opioid utilization following hepatopancreatic surgery

Utilization and evolving prescribing practice of opioid and non‐opioid analgesics in patients undergoing lymphadenectomy for cutaneous malignancy

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