Patterns of opioid use in dialysis access procedures

Janek, Kevin C.; Bennett, Kyla M.; Imbus, Joseph R.; Danobeitia, Juan S.; Philip, Jennifer L.; Melnick, David M.

doi:10.1016/j.jvs.2019.12.033

Cited by 5 publications

(7 citation statements)

References 12 publications

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“…However, Janek et al report similar opioid use of a median of 5.5 hydrocodone 5 mg pills for long incision and 1.75 hydrocodone 5 mg pills for short incision procedures, and 31% of patients used no opioids. 18 We found similar opioid consumption in our patients with a median of 3.5 and 0 opioid 5 mg oxycodone pills for long and short incision procedures, respectively, which converts to similar morphine equivalents. In our study, > 50% of patients consumed no opioids whatsoever.…”

Section: Discussionsupporting

confidence: 63%

Postoperative Opioid Prescription and Use After Outpatient Vascular Access Surgery

Santos‐Parker¹,

Yoshida

Hallway

et al. 2021

Journal of Surgical Research

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Background: Larger opioid prescriptions are associated with increased consumption without improvements in pain, and the majority of opioids prescribed go unused. We examined postoperative opioid prescription and use in patients undergoing vascular access surgery, where preoperative opioid exposure is common.Methods: A retrospective analysis was conducted in adult CKD patients who underwent outpatient vascular access surgery. Patients were surveyed by telephone > 2 weeks after surgery to assess pain level and opioid and non-opioid medication use. Results:Of 117 patients contacted, 76 responded (65% response rate), with a median (interquartile range) age of 56 (42-69) years. Sixty-three patients (83%) were prescribed an opioid postoperatively. Respondents were prescribed 60 (38-75) oral morphine equivalents (OMEs) and consumed 0 (0-15) OMEs over 1 day with a pain score of 5 out of 10. Thirtynine patients ( > 50%) used no opioids. There were no differences in postoperative opioid prescribing or use in patients with recent opioid exposure compared to patients without.Patients who underwent arteriovenous fistula (AVF) creation (short surgical incision procedure) were prescribed 60 (38-75) OMEs, compared with 75 (56-111) OMEs for patients who underwent AVF superficialization, AVG, or BVT (long surgical incision procedure; P < 0.01) and consumed 0 (0-15) OMEs compared with 10 (0-43) OMEs, respectively ( P = 0.07). Conclusion:Regardless of preoperative opioid exposure, CKD patients undergoing vascular access surgery consumed fewer opioids than prescribed, with a median of < 10% of opioids used. Therefore, we've reduced our institutional prescribing recommendations to 4 and 6 oxycodone 5mg pills for short and long surgical incision procedures, respectively.

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Section: Discussionsupporting

confidence: 63%

Postoperative Opioid Prescription and Use After Outpatient Vascular Access Surgery

Santos‐Parker¹,

Yoshida

Hallway

et al. 2021

Journal of Surgical Research

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“…We chose to examine the 75th percentile as prior studies and guidelines have used this value as an outlier threshold for typical opioid consumption. [11][12][13] All data were collected and managed using Research Electronic Data Capture. 14 The study was reviewed and approved by the institutional review board at our institution.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of U.S. State Opioid Prescribing Restrictions Using Patient Opioid Consumption Patterns from a Single, Urban, Academic Institution

et al. 2022

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Background:Since 2017, states, insurers, and pharmacies have placed blanket limits on the duration and quantity of opioid prescriptions. In many states, overlapping duration and daily dose limits yield maximum prescription limits of 150–350 morphine milligram equivalents (MMEs). There is limited knowledge of how these restrictions compare with actual patient opioid consumption; while changes in prescription patterns and opioid misuse rates have been studied, these are, at best, weak proxies for actual pain control consumption. We sought to determine how patients undergoing surgery would be affected by opioid prescribing restrictions using actual patient opioid consumption data. Methods: We constructed a prospective database of post-discharge opioid consumption: patients undergoing surgery at one institution were called after discharge to collect opioid consumption data. Patients whose opioid consumption exceeded 150 and 350 MME were identified. Results: Two thousand nine hundred and seventy-one patients undergoing 54 common surgical procedures were included in our study. Twenty-one percent of patients consumed more than the 150 MME limit. Only 7% of patients consumed above the 350 MME limit. Typical (non-outlier) opioid consumption, defined as less than the 75th percentile of consumption for any given procedure, exceeded the 150 MME and 350 MME limits for 41 and 7% of procedures, respectively. Orthopedic, spinal/neurosurgical, and complex abdominal procedures most commonly exceeded these limits. Conclusions: While most patients undergoing surgery are unaffected by recent blanket prescribing limits, those undergoing a specific subset of procedures are likely to require more opioids than the restrictions permit; providers should be aware that these patients may require a refill to adequately control post-surgical pain. Real consumption data should be used to guide these restrictions and inform future interventions so the risk of worsened pain control (and its troublesome effects on opioid misuse) is minimized. Procedure-specific prescribing limits may be one approach to prevent misuse, while also optimizing post-operative pain control.

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“…It is estimated 125,000 people are diagnosed as having ESRD annually. 5 Patients with ESRD typically require surgical procedures to allow access for hemodialysis, including autologous arteriovenous (AV) fistulas and nonautologous AV grafts, which can require additional surgical procedures to ensure their function. It is estimated that the failure rate after fistula creation can be as high as 38.9%.…”

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confidence: 99%

“…It is estimated that the failure rate after fistula creation can be as high as 38.9%. 5 Each additional procedure causes physical pain and often can require larger incisions and longer procedures. Poorly controlled postoperative pain in patients can contribute to chronic pain.…”

mentioning

confidence: 99%

“…Patients with end-stage renal disease (ESRD) are a particularly vulnerable population in terms of chronic pain. It is estimated 125,000 people are diagnosed as having ESRD annually 5 . Patients with ESRD typically require surgical procedures to allow access for hemodialysis, including autologous arteriovenous (AV) fistulas and nonautologous AV grafts, which can require additional surgical procedures to ensure their function.…”

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confidence: 99%

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Pain after Arteriovenous Access Creation

Howk¹,

McAdams²,

Heidel³

et al. 2022

Southern Medical Journal

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Objectives: Dialysis access creation is a common outpatient procedure that can be completed using general, regional, or local anesthetic techniques. There are few endorsed guidelines regarding opioid-based pain control following fistula creation. The purpose of this study was to determine whether utilization of regional anesthesia (RA) is associated with the decreased use of narcotics postoperatively.Methods: We performed a prospective cohort study including all patients undergoing arteriovenous fistula creation with one vascular surgeon from August 2019 to February 2020. Patients were selected for regional versus general anesthesia. Selection for anesthesia type was determined by the primary anesthesiologist. Patients selected for RA underwent supraclavicular brachial plexus block with 30 cm 3 of 0.5% ropivacaine. Patients were seen in clinic follow-up and completed a questionnaire regarding their postoperative opiate use and pain control.Results: In the study period, 52 patients underwent arteriovenous fistula creation and completed the follow-up questionnaire. Forty patients received RA. Seventy-five percent of patients sent home with a narcotic prescription filled the prescription. There was a significant difference in postoperative opioid use between the two study groups. Patients who received regional block took on average 3.3 pills totaling 16.5 morphine milligram equivalents, whereas patients who received general anesthesia took on average 6.64 pills totaling 33.2 morphine milligram equivalents ( P = 0.04).Conclusions: Morbidity and mortality related to opiate use continues to be a public health issue in the United States. This study demonstrates that regional anesthetic techniques in comparison to general anesthesia can result in a significant decrease in postoperative opiate consumption.

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Patterns of opioid use in dialysis access procedures

Cited by 5 publications

References 12 publications

Postoperative Opioid Prescription and Use After Outpatient Vascular Access Surgery

Postoperative Opioid Prescription and Use After Outpatient Vascular Access Surgery

Evaluation of U.S. State Opioid Prescribing Restrictions Using Patient Opioid Consumption Patterns from a Single, Urban, Academic Institution

Pain after Arteriovenous Access Creation

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