Male gender, smoking, younger age, and preoperative pain found to increase postoperative opioid requirements in 592 elective colorectal resections

Abstract

With increased awareness of the opioid epidemic, understanding contributing factors to postoperative opioid use is important. The purpose of this study was to evaluate patient and perioperative factors that contribute to postoperative opioid use after colorectal resections and their relation to pre-existing pain conditions and psychiatric diagnoses. MethodsA retrospective review was conducted identifying adult patients who underwent elective colorectal resection at a single tertiary center between 2015 and 2018. Patient demographics, preoperative factors, surgical approach, and perioperative pain management were evaluated to determine standard conversion morphine milligram equivalents required for postoperative days 0 to 3 and total hospital stay. ResultsFive hundred and ninety-two patients: 46% male, median age 58 years undergoing colorectal resections for indications including cancer, in ammatory bowel disease, and diverticulitis were identi ed. Less opioid use was found to be associated with female gender (β = -42), patients who received perioperative lidocaine infusion (β = -30), and older adults (equivalents/year) (β = -4, all p < 0.01). Preoperative opioid use, preoperative abdominal pain, epidural use and smoking were all independently associated with increased postoperative opioid requirements. ConclusionsIn this study of patients undergoing elective colorectal resection, factors that were associated with higher perioperative opioid use included male gender, smoking, younger age, preoperative opioid use, preoperative abdominal pain, and epidural use. Perioperative administration of lidocaine was associated with decreased opioid requirements. Understanding risk factors and stratifying postoperative pain regimens may aid in improved pain control and decrease long-term dependency.

A Meta-Analysis Showing the Quantitative Evidence Base of Preemptive Pregabalin for Postoperative Pain from Cancer-Related Surgery

“…Opioids, such as morphine, are the most widely used prescription analgesics for acute moderate to severe postoperative pain in cancer-related surgery [ 5 , 6 ]. However, when high doses of opioids are used, in addition to the risks of respiratory depression, tolerance, nausea, and vomiting (PONV) [ 7 ], they can also increase the risks of metastasis and recurrence [ 8 ].…”