The cost-effectiveness of epidural, patient-controlled intravenous opioid analgesia, or transversus abdominis plane infiltration with liposomal bupivacaine for postoperative pain management

Babazade, Rovnat; Saasouh, Wael; Naylor, Amanda J.; Makarova, Natalya; Udeh, Chiedozie; Turan, Alparslan; Udeh, Belinda

doi:10.1016/j.jclinane.2018.10.003

Cited by 19 publications

(9 citation statements)

References 31 publications

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“…As expected, duration of induction of anaesthesia was shorter with CWI in our trial, which is a relevant economic advantage for our health care system compared to EDA. This supports recent studies that have outlined the high costs associated with EDA [7].…”

Section: Safetysupporting

confidence: 91%

“…Specifically, EDA has been criticised for causing rare, but serious adverse events, its multiple contraindications, high failure rates [6], associated high personal and material costs [7] and the associated immobilization patients due to equipment and urinary catheters [4]. Despite these disadvantages, EDA compares favourably to systematic opioid use in some surgical specialties and for high risk patients [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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Continuous wound infiltration versus epidural analgesia for midline abdominal incisions – a randomized-controlled pilot trial (Painless-Pilot trial; DRKS Number: DRKS00008023)

et al. 2020

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Objectives To test the feasibility of a randomized controlled study design comparing epidural analgesia (EDA) with continuous wound infiltration (CWI) in respect to postoperative complications and mobility to design a future multicentre randomized controlled trial. Design, setting, participants CWI has been developed to address drawbacks of EDA. Previous studies have established the equivalent analgesic potential of CWI compared to EDA. This is a single centre, nonblinded pilot randomized controlled trial at a tertiary surgical centre. Patients undergoing elective non-colorectal surgery via a midline laparotomy were randomized to EDA or CWI. Endpoints included recruitment, feasibility of assessing postoperative mobility with a pedometer and morbidity. No primary endpoint was defined and all analyses were explorative. Interventions CWI with local anaesthetics (experimental group) vs. thoracic EDA (control). Results Of 846 patients screened within 14 months, 71 were randomized and 62 (31 per group) included in the intention-to-treat analysis. Mobility was assessed in 44 of 62 patients and revealed no differences within the first 3 postoperative days. Overall morbidity did not differ between the two groups (measured via the comprehensive complication index). Median

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Section: Safetysupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Continuous wound infiltration versus epidural analgesia for midline abdominal incisions – a randomized-controlled pilot trial (Painless-Pilot trial; DRKS Number: DRKS00008023)

et al. 2020

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“…With the advent of the opioid crisis, the use of opioids in major abdominal surgeries is being discouraged. Epidural analgesia, previously known as the gold standard for postoperative pain control after major abdominal surgeries, is also being replaced by another multimodal analgesia due to disadvantages such as hypotension, urinary retention, rare but serious complications, and low cost-effectiveness [ 29 , 30 ]. Therefore, anesthesiologists should find the optimal analgesic method to effectively control postoperative pain while reducing postoperative complications in patients undergoing PD, based on the latest evidence.…”

Section: Discussionmentioning

confidence: 99%

Effect of postoperative non-steroidal anti-inflammatory drugs on anastomotic leakage after pancreaticoduodenectomy

Yoon

Kim

Cho

et al. 2022

Korean J Anesthesiol

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“…At first glance, the simple injection of morphine intramuscularly or the administration of long-acting oral pain medication appear much more efficient than using PCA. However, depending on the initial indication for surgery, the type of PCA, national cost schedules, and the chosen comparator, it is selected whether PCA is cost-effective or not [56][57][58][59]. As these factors vary, a universal statement is not viable.…”

Section: Financesmentioning

confidence: 99%

Quo Vadis PCA? A Review on Current Concepts, Economic Considerations, Patient-Related Aspects, and Future Development with respect to Patient-Controlled Analgesia

Nardi-Hiebl

Eberhart

Gehling

et al. 2020

Anesthesiology Research and Practice

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This review assesses four interrelating aspects of patient-controlled analgesia (PCA), a long-standing and still widely used concept for postoperative pain management. Over the years, anaesthesiologists and patients have appreciated the benefits of PCA alike. The market has seen new technologies leveraging noninvasive routes of administration and, thus, further increasing patient and staff satisfaction as well as promoting safety aspects. Pharmaceutical research focuses on the reduction or avoidance of opioids, side effects, and adverse events although influence of these aspects appears to be minor. The importance of education is still eminent, and new educational formats are tested to train healthcare professionals and patients likewise. New PCA technology can support the implementation of efficient processes to reduce workload and human errors; however, these new products come with a cost, which is not necessarily reflected through beneficial budget impact or significant improvements in patient outcome. Although first steps have been taken to better recognize the importance of postoperative pain management through the introduction of value-based reimbursement, in most western countries, PCA is not specifically compensated. PCA is still an effective and valued technique for postoperative pain management. Although there is identifiable potential for future developments in various aspects, this potential has not materialized in new products.

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The cost-effectiveness of epidural, patient-controlled intravenous opioid analgesia, or transversus abdominis plane infiltration with liposomal bupivacaine for postoperative pain management

Cited by 19 publications

References 31 publications

Continuous wound infiltration versus epidural analgesia for midline abdominal incisions – a randomized-controlled pilot trial (Painless-Pilot trial; DRKS Number: DRKS00008023)

Continuous wound infiltration versus epidural analgesia for midline abdominal incisions – a randomized-controlled pilot trial (Painless-Pilot trial; DRKS Number: DRKS00008023)

Effect of postoperative non-steroidal anti-inflammatory drugs on anastomotic leakage after pancreaticoduodenectomy

Quo Vadis PCA? A Review on Current Concepts, Economic Considerations, Patient-Related Aspects, and Future Development with respect to Patient-Controlled Analgesia

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