Postoperative Opioid Use Is Associated with Increased Rates of Grade B/C Pancreatic Fistula After Distal Pancreatectomy

Boyev, Artem; Prakash, Laura R.; Chiang, Yi‐Ju; Childers, Christopher P.; Jain, Anish J.; Newhook, Timothy E.; Bruno, Morgan L.; Arvide, Elsa M.; Dewhurst, Whitney L.; Kim, Michael P.; Ikoma, Naruhiko; Lee, Jeffrey E.; Snyder, Rebecca A.; Katz, Matthew H.; Tzeng, Ching‐Wei D.; Maxwell, Jessica E.

doi:10.1007/s11605-023-05751-4

Cited by 1 publication

(3 citation statements)

References 57 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Following DP, there was no difference in CR-POPF rates in patients receiving intraoperative and postoperative epidural or intravenous fentanyl PCA [96]. However, other studies have shown that patients who consumed less morphine after DP had less CR-POPF [71,72]. As such, the impact of opiates on CR-POPF requires further clarification, particularly given their adverse effects of respiratory depression, excessive sedation, and intestinal dysmotility [72,83].…”

Section: Analgesiamentioning

confidence: 97%

“…Another mechanism through which dexamethasone may protect against CR-POPF is by decreasing the use of opioids [70]. While total morphine equivalents were a significant predictor of CR-POPF after DP [71,72], this has yet to be confirmed in PD patients. Therefore, dexamethasone may curb the development of CR-POPF by reducing inflammation, infection, and opioid use.…”

Section: Dexamethasonementioning

confidence: 99%

“…However, other studies have shown that patients who consumed less morphine after DP had less CR-POPF [71,72]. As such, the impact of opiates on CR-POPF requires further clarification, particularly given their adverse effects of respiratory depression, excessive sedation, and intestinal dysmotility [72,83]. While this is being elucidated, multimodal analgesia involving lidocaine, regional nerve blockades, and ketamine has been recommended to reduce opioid consumption [97].…”

Section: Analgesiamentioning

confidence: 99%

See 2 more Smart Citations

Non-Surgical Interventions for the Prevention of Clinically Relevant Postoperative Pancreatic Fistula—A Narrative Review

Rykina-Tameeva,

Samra,

Sahni

et al. 2023

Cancers

View full text Add to dashboard Cite

Clinically relevant postoperative pancreatic fistula (CR-POPF) is the leading cause of morbidity and mortality after pancreatic surgery. Post-pancreatectomy acute pancreatitis (PPAP) has been increasingly understood as a precursor and exacerbator of CR-POPF. No longer believed to be the consequence of surgical technique, the solution to preventing CR-POPF may lie instead in non-surgical, mainly pharmacological interventions. Five databases were searched, identifying eight pharmacological preventative strategies, including neoadjuvant therapy, somatostatin and its analogues, antibiotics, analgesia, corticosteroids, protease inhibitors, miscellaneous interventions with few reports, and combination strategies. Two further non-surgical interventions studied were nutrition and fluids. New potential interventions were also identified from related surgical and experimental contexts. Given the varied efficacy reported for these interventions, numerous opportunities for clarifying this heterogeneity remain. By reducing CR-POPF, patients may avoid morbid sequelae, experience shorter hospital stays, and ensure timely delivery of adjuvant therapy, overall aiding survival where prognosis, particularly in pancreatic cancer patients, is poor.

show abstract