Postoperative Opioid Prescription and Use After Outpatient Vascular Access Surgery

Santos‐Parker, Jessica R.; Yoshida, Maxwell; Hallway, Alexander; Englesbe, Michael J.; Woodside, Kenneth J.; Howard, Ryan

doi:10.1016/j.jss.2021.02.005

Cited by 2 publications

(2 citation statements)

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“…Opiate prescribing and consumption patterns following dialysis access procedures have been evaluated recently. The results demonstrated that patients are receiving prescriptions that have significantly higher MMEs than they are consuming, as well as increased MME prescribing and consumption for patients undergoing a long-incision procedure (AV graft, basilic vein transposition, AV fistula superficialization) versus a short-incision procedure 14 . Regardless of anesthesia selection or dialysis access type (long incision versus short incision), all of the patients who were written a prescription in this study received 60 MMEs.…”

Section: Discussionmentioning

confidence: 79%

“…The results demonstrated that patients are receiving prescriptions that have significantly higher MMEs than they are consuming, as well as increased MME prescribing and consumption for patients undergoing a long-incision procedure (AV graft, basilic vein transposition, AV fistula superficialization) versus a short-incision procedure. 14 Regardless of anesthesia selection or dialysis access type (long incision versus short incision), all of the patients who were written a prescription in this study received 60 MMEs. Both cohort groups reported consuming fewer MMEs than prescribed, many patients from both groups reported not filling their prescription, and there was no difference in consumption between short-incision versus long-incision groups.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%