Achieving the Goal of Opioid-Free Surgery: Lessons Learned from More than One Hundred Narcotic-Free Enhanced Recovery After Surgery Colectomies

Horattas, Sophia; Bahr, Kelly; Reissig, James; Horattas, Mark C.

doi:10.1016/j.jamcollsurg.2018.07.120

Cited by 3 publications

(5 citation statements)

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“…Although complete opioid avoidance has been described in other surgical populations, (14)(15)(16) ours is the first to demonstrate its feasibility after LT. There are few reports addressing perioperative pain management in LT recipients (13,(21)(22)(23)(24)(25) ; however, there are none describing an opioid avoidance approach.…”

Section: Discussionmentioning

confidence: 89%

“…Postoperative multimodal analgesic approaches have demonstrated reduced opioid utilization in many surgical populations including LT recipients. (9)(10)(11)(12)(13) Despite the abundance of studies on postoperative multimodal analgesia, few have attempted opioid avoidance, (14)(15)(16) with no reported attempts in LT recipients. Given the association between a history of substance use disorder…”

Section: See Editorial On Page 1221mentioning

confidence: 99%

“…Postoperative multimodal analgesic approaches have demonstrated reduced opioid utilization in many surgical populations including LT recipients. ( 9‐13 ) Despite the abundance of studies on postoperative multimodal analgesia, few have attempted opioid avoidance, ( 14‐16 ) with no reported attempts in LT recipients. Given the association between a history of substance use disorder (SUD) and the risk of postsurgical opioid use disorder, ( 17 ) our LT team sought to develop a comprehensive multidisciplinary opioid avoidance pathway (OAP) for our LT recipients.…”

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confidence: 99%

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Opioid Avoidance in Liver Transplant Recipients: Reduction in Postoperative Opioid Use Through a Multidisciplinary Multimodal Approach

Kutzler¹,

Gannon²,

Nolan³

et al. 2020

Liver Transpl.

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The prevalence of substance use disorder in the liver transplantation (LT) population makes postoperative pain management challenging. We report our initial experience with a novel, comprehensive, multidisciplinary opioid avoidance pathway in 13 LT recipients between January 2018 and September 2019. Patients received comprehensive pre‐LT education on postoperative opioid avoidance by the surgeon, pharmacist, and psychologist at the time of listing. Immediately after LT, patients received a continuous incisional ropivacaine infusion, ketamine, acetaminophen, and gabapentin as standard nonopioid medications; rescue opioids were used as needed. We compared outcomes with a historical cohort of 27 LT recipients transplanted between August 2016 and January 2018 managed primarily with opioids. On average, opioid avoidance patients used 92% fewer median (interquartile range [IQR]) morphine milligram equivalents (MMEs) versus the historical cohort (7 [1‐11] versus 87 [60‐130] MME; P < 0.001) per postoperative day over a similar length of stay (8 [7‐10] versus 6 [6‐10] days; P = 0.14). Fewer outpatient MMEs were prescribed within the first 60 days after LT in the opioid avoidance group versus the historical cohort: 125 (25‐150) versus 270 (0‐463) MME (P = 0.05). This proof‐of‐concept study outlines the potential to profoundly reduce opioid utilization in the LT population using a comprehensive multidisciplinary approach.

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Section: Discussionmentioning

confidence: 89%

Section: See Editorial On Page 1221mentioning

confidence: 99%

mentioning

confidence: 99%

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Opioid Avoidance in Liver Transplant Recipients: Reduction in Postoperative Opioid Use Through a Multidisciplinary Multimodal Approach

Kutzler¹,

Gannon²,

Nolan³

et al. 2020

Liver Transpl.

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“…Pathologic stage (stage 0 vs III-IV: HR=0. 19 On log-transformed multivariate linear regression modeling of total narcotic use (POD1-3), patients who underwent ICUD had significantly lower total narcotic usage even after adjusting for TAP block (Table 4). Compared to ECUD, ICUD patients were estimated to consume 52.3% less opioids (beta=-0.74, 95%CI…”

Section: Resultsmentioning

confidence: 99%

“…Studies have shown that even opioid-naïve patients are at risk for persistent postoperative opioid use [17,18]. In response to the current crisis, surgeons across fields have adopted various tools and techniques to minimize narcotic consumption, combatting the opioid epidemic within their own realm of influence [19][20][21]. As ICUD is less invasive than ECUD, we hypothesized that ICUD in the setting of a dedicated Enhanced Recovery After Surgery (ERAS) protocol driving post-operative pain management would reduce postoperative pain and narcotic consumption, offering urologists another valuable tool to combat this epidemic and contribute to improvement on a broader scale.…”

Section: Introductionmentioning

confidence: 99%

Robotic Cystectomy with Intracorporeal Urinary Diversion is Associated with Decreased Narcotic Consumption

Riggs

2023

JOJUN

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Introduction: Improvements in robotic technology and surgeon experience have made intracorporeal ileal conduit urinary diversion (ICUD) following robot-assisted radical cystectomy (RARC) a reality. Thus, it is essential to understand the benefits and drawbacks to this technically challenging approach. This study investigates surgical and pain-related perioperative outcomes in patients who underwent ICUD compared to extracorporeal urinary diversion (ECUD) at a tertiary care center. Methods: We reviewed a prospectively maintained database of 198 patients who underwent robot-assisted radical cystectomy between January 2015 and October 2020. Surgical, functional, and pain-related perioperative outcomes were compared between 177 patients who received either ICUD or ECUD. Results and Conclusion: Among 177 patients, 107 (60.4%) patients underwent ECUD and 70 (39.6%) underwent ICUD. Patients who received ICUD had significantly lower narcotic consumption (P=.031). There were no significant differences across cohorts in operative time (P=.10), estimated blood loss (P=.958), blood transfusion rate (P=.267), overall survival (P=.485), LOS (P=.652), or 30-day readmissions (P=.080). Our study suggests that RARC with intracorporeal ileal conduit reduces post-operative narcotic use as compared to extracorporeal diversion. Further validation across multiple institutions will be required to elucidate the full advantage and/or disadvantage to this approach.

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The impact of preoperative opioid use on outcomes after elective colorectal surgery: A propensity-matched comparison study

Cortez

Freeman

Levinsky

et al. 2019

Surgery

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Achieving the Goal of Opioid-Free Surgery: Lessons Learned from More than One Hundred Narcotic-Free Enhanced Recovery After Surgery Colectomies

Cited by 3 publications

References 0 publications

Opioid Avoidance in Liver Transplant Recipients: Reduction in Postoperative Opioid Use Through a Multidisciplinary Multimodal Approach

Opioid Avoidance in Liver Transplant Recipients: Reduction in Postoperative Opioid Use Through a Multidisciplinary Multimodal Approach

Robotic Cystectomy with Intracorporeal Urinary Diversion is Associated with Decreased Narcotic Consumption

The impact of preoperative opioid use on outcomes after elective colorectal surgery: A propensity-matched comparison study

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