The Impact of Enhanced Recovery After Surgery on Persistent Opioid Use Following Pulmonary Resection

Turner, Kevin M.; Delman, Aaron M.; Griffith, Azante; Wima, Koffi; Wallen, Taylor E; Starnes, Sandra L.; Budde, Bradley M; Haren, Robert M. Van

doi:10.1016/j.athoracsur.2022.05.059

Cited by 8 publications

(10 citation statements)

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“…Our findings agree with research demonstrating that patients undergoing a pulmonary resection treated with a regional block and MMA utilized decreased MME compared to the pre-MMA cohort during admission and at discharge, but similar opioid use at 14-90 and 90-180 days postoperatively. 5 This data combined with the current study raises concerns that MMA protocols may not modify opioid use long-term. Future studies should prospectively evaluate direct measures of opioid use, further investigate the finding that MMA patients were more likely to fill an opioid prescription, and prioritize patients with…”

Section: Discussionmentioning

confidence: 65%

“…known risk factors for chronic opioid use such as tobacco use and advanced pathologic T-stage. 5,6 Limitations of the current study include its small sample size and retrospective nature; it was only able to measure opioid prescriptions filled and could not account for actual use. 5 Additionally, discharge pain regimens were not standardized in the current study, which could present a limitation, although any attempt to standardize discharge regimens could prove challenging.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 Limitations of the current study include its small sample size and retrospective nature; it was only able to measure opioid prescriptions filled and could not account for actual use. 5 Additionally, discharge pain regimens were not standardized in the current study, which could present a limitation, although any attempt to standardize discharge regimens could prove challenging. Finally, pain was assessed only at postoperative visits rather than throughout recovery, which may limit generalizability.…”

Section: Discussionmentioning

confidence: 99%

“…This data combined with the current study raises concerns that MMA protocols may not modify opioid use long‐term. Future studies should prospectively evaluate direct measures of opioid use, further investigate the finding that MMA patients were more likely to fill an opioid prescription, and prioritize patients with known risk factors for chronic opioid use such as tobacco use and advanced pathologic T‐stage 5,6 …”

Section: Discussionmentioning

confidence: 99%

“…Data collected included pain scores within 6 weeks of follow up, as well as discharge pain regimen and opioid prescriptions filled from the Kansas prescription monitoring program, K-TRACS, calculated in average Morphine Milligram Equivalents (MME) per day. 5 Pain scores were measured using the visual analog pain scale (VAS).…”

Section: Introductionmentioning

confidence: 99%

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Six‐week postoperative opioid use and pain following a randomized controlled trial evaluating multimodal analgesia for head and neck free flap patients

Wagoner,

Lawrence,

Alapati

et al. 2024

Laryngoscope Investig Oto

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IntroductionHead and neck malignancy treatment often involves invasive surgeries, necessitating effective postoperative pain control. However, chronic reliance on opioid medications remains a challenge for many patients after surgery. Multimodal analgesia (MMA) within enhanced recovery after surgery protocols has shown success in limiting narcotic pain medications for other cancer types. In a prior study, MMA comprising acetaminophen, ketorolac, gabapentin, and a neurogenic block reduced opioid use in the 7‐day postoperative period for major head and neck reconstructive surgery. This study investigates the impact of multimodal analgesia on opioid prescription and pain during the 6‐week postoperative period for patients undergoing major head and neck oncologic surgeries, aiming to understand the longer‐term effects of narcotic use.MethodsThe study retrospectively examined participants in a [hybrid type 1 effectiveness‐implementation pragmatic trial to assess multimodal analgesia's long‐term effectiveness in head and neck free flap surgery. Arm A received scheduled acetaminophen and as‐needed opioids, while Arm B received scheduled gabapentin, ketorolac, a regional nerve block at the donor site, scheduled acetaminophen, and as‐needed opioids. Retrospective data collection included opioid prescription use and pain scores up to 6 weeks after surgery, gathered from the Kansas prescription drug monitoring program, K‐TRACS.ResultsThirty patients participated, 14 in Arm A and 16 in Arm B. The average morphine milligram equivalents per day of filled prescriptions were not significantly different between Arm A and Arm B (7.23 vs. 7.88, p = .845). Additionally, average pain scores at 6 weeks showed no significant difference between the two groups (1.4 vs. 1.9, p = .612).ConclusionPatients with head and neck cancer treated with multimodal analgesia during the perioperative period did not exhibit significant differences in opioid use and pain within 6 weeks after discharge. To confirm these findings, a re‐examination with strict measures of opioid use and scheduled pain assessments in a prospective manner is warranted.Level of Evidence4.

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Section: Discussionmentioning

confidence: 65%