Opioid-Sparing Effect of Liposomal Bupivacaine and Intravenous Acetaminophen in Colorectal Surgery

Rizk, Elsie; Haas, Eric M.; Swan, Joshua T.

doi:10.1016/j.jss.2020.09.002

Cited by 5 publications

(4 citation statements)

References 32 publications

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“…The first postoperative day opioid consumption (in morphine milligram equivalents) in our cohort (0.7 mg/kg/day) compares favorably to a report by Rizk et al of adult patients who underwent open and laparoscopic colorectal surgery without regional anesthesia receiving 44 and 21 mg/kg/day, respectively [27]. A smaller retrospective study reported a mean opioid consumption of 0.2 mg/kg/day in pediatric patients who received the QLB for colorectal surgery, though it is unclear whether this measurement was limited to the first postoperative day or averaged for the entire hospital course [28].…”

Section: Discussionsupporting

confidence: 83%

Quadratus Lumborum Blockade for Postoperative Analgesia in Infants and Children Following Colorectal Surgery

et al. 2023

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Background: Adult studies have indicated that the quadratus lumborum block (QLB) may provide superior analgesia compared to singleshot neuraxial and other truncal peripheral nerve blocks. The technique is being increasingly used for postoperative analgesia in children undergoing lower abdominal surgery. To date, these pediatric reports have been limited by small sample sizes, which may hinder the interpretation of results and assessment of safety. In this study, we retrospectively examined QLBs performed at a large tertiary care hospital for evidence of effectiveness and safety in the pediatric colorectal surgery population.Methods: Patients less than 21 years of age who underwent abdominal surgery and received a unilateral or bilateral QLB over a 4-year period were identified in the electronic medical record. Patient demographics, surgery type, and QLB characteristics were retrospectively examined. Pain scores and opioid consumption were tabulated over the first 72-h postoperative period. QLB procedural complications or adverse events attributable to the regional anesthetic were obtained. Results:The study cohort included 204 QLBs in 163 pediatric-aged patients (2 days to 19 years of age, median age of 2.4 years). The most common indication was unilateral blockade for ostomy creation or reversal. The majority of QLBs were performed using ropivacaine 0.2% with a median volume of 0.6 mL/kg. The median opioid requirement in oral morphine milligram equivalents (MMEs) was 0.7, 0.5, and 0.3 MME/kg on the first, second, and third postoperative days, respectively. Median pain scores were less than 2 over each time period. Aside from block failure (incidence 1.2%), there were no complications or postoperative adverse events related to the QLBs. Conclusion:This retrospective review in a large cohort of pediatric patients demonstrates that the QLB can be performed safely and efficiently in children undergoing colorectal surgery. The QLB provides adequate postoperative analgesia, has a high success rate, may limit postoperative opioid consumption, and is associated with a limited adverse effect profile.

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Section: Discussionsupporting

confidence: 83%

Quadratus Lumborum Blockade for Postoperative Analgesia in Infants and Children Following Colorectal Surgery

et al. 2023

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“…George et al reported an average 24-h postoperative pain score of 4.5 in 148 children who underwent laparoscopic and open colorectal surgery without the use of adjunctive regional anesthesia [ 25 ]. The median postoperative pain score was 2.1 in our cohort of patients during the first 24 postoperative hours with a reduction in the need for systemic opioids [ 26 ]. The analgesic efficacy of the QLB in our cohort is likely attributable to analgesic coverage of somatic abdominal pain.…”

Section: Discussionmentioning

confidence: 99%

Preliminary Experience With Quadratus Lumborum Catheters for Postoperative Pain Management in Pediatric-Aged Patients With Contraindications to Epidural Anesthesia

et al. 2022

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Background: Although neuraxial techniques such as caudal and epidural anesthesia were initially the predominant regional anesthetic technique used to provide postoperative analgesia in children, there has been a transition to the use of peripheral nerve blockade such as the quadratus lumborum block (QLB). We present preliminary experience with QL catheters for continuous postoperative analgesia in a cohort of pediatric patients following colorectal surgery.Methods: After institutional review board (IRB) approval, we retrospectively reviewed the records of patients who underwent major colorectal surgery and received QL catheters for postoperative analgesia. The postoperative pain control data consisted of QL catheter characteristics, anesthetic agents, adjuncts, pain scores, and opioid consumption during the postoperative period. Results:The study cohort included eight pediatric patients, ranging in age from 1 to 19 years (median age 11.8 years). The QL catheters were placed in the operating room after the induction of anesthesia. Comorbid conditions in the cohort that were contraindications to neuraxial anesthesia included spinal/vertebral malformations, presence of a ventriculoperitoneal (VP) shunt, anal atresia, tracheo-esophageal fistula (VACTERL) association, and coagulation disturbances. All patients underwent complex colorectal or genito-urologic procedures. Bilateral QL catheters were placed in six patients, and unilateral catheters were placed in two patients. Four patients received 0.5% ropiva-caine and four patients received 0.2% ropivacaine of an initial bolus. The local anesthetic used for continuous infusion was 0.2% ropivacaine in five patients, 0.1% ropivacaine in two patients, and 1.5% chloroprocaine in one patient, with a median infusion rate of 0.11 mL/kg/h. QL catheter infusions were supplemented with intravenous opioids delivered by patient-controlled or nurse-controlled analgesia. The median opioid requirements in oral morphine milligram equivalents (MME) were 1.2, 1.0, 1.1, 0.5, and 0.6 MME/kg on postoperative days 1 -5. Daily median pain scores were ≤ 2 during the 5-day postoperative course. All catheters functioned successfully and were in place for a median of 79.3 h. Other than early inadvertent removal of two catheters, no adverse effects were noted.Conclusions: Although our preliminary data suggest the efficacy of QL catheters in providing prolonged postoperative analgesia for up to 3 -5 days following colorectal procedures, attention needs to be directed at measures to ensure that the catheter is secured to avoid inadvertent removal.

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“…18 A lower incidence of postoperative ileus and a shorter duration of hospital stay have also been observed with the use of opioids sparing liposomal bupivacaine. 19 When it comes to postoperative pain outcomes, opioid-inclusive anaesthesia does not show much of an advantage over opioid-free techniques. It was observed by Frauenknecht et al that the opioidfree regimen also resulted in a 20% decrease in postoperative nausea and vomiting.…”

Section: Discussionmentioning

confidence: 99%

Anesthesia without opioids

Butt¹,

Faraz²,

Fazal³

2022

Anaesth. pain intensive care

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Summary Opium was the first opioids with sedative and analgesic effects, so was readily adopted by the surgical doctors to be used during surgeries. Later on its natural alkaloid, morphine, was extensively used, till synthetic alkaloids were introduced in the clinical practice. Now many non-narcotic analgesic drugs have been synthesized and proven to be devoid of serious side effects, commonly associated with the opioid use. There have been some staunch advocates of non-narcotic based anesthesia, who claim that the side effects of the opioids outweigh their benefits in the anesthesia. This editorial throws some light on the current and the future trends in analgesic use in anesthesia. Key words: Opioids; Analgesics; Non-opioid analgesics; Perioperative pain; Side effects Citation: Butt MN, Faraz A, Fazal M. Anesthesia without opioids (Editorial). Anaesth. pain intensive care 2021;26(1):4–7; DOI: 10.35975/apic.v26i1.1758 Received: January 10, 2022, Accepted: January 12, 2022

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Opioid-Sparing Effect of Liposomal Bupivacaine and Intravenous Acetaminophen in Colorectal Surgery

Cited by 5 publications

References 32 publications

Quadratus Lumborum Blockade for Postoperative Analgesia in Infants and Children Following Colorectal Surgery

Quadratus Lumborum Blockade for Postoperative Analgesia in Infants and Children Following Colorectal Surgery

Preliminary Experience With Quadratus Lumborum Catheters for Postoperative Pain Management in Pediatric-Aged Patients With Contraindications to Epidural Anesthesia

Anesthesia without opioids

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