Analgesic Opioid Dose Is an Important Indicator of Postoperative Ileus Following Radical Cystectomy with Ileal Conduit: Experience in the Robotic Surgery Era

Koo, Kyo Chul; Yoon, Young Eun; Chung, Byung Ha; Hong, Sung Joon; Rha, Koon Ho

doi:10.3349/ymj.2014.55.5.1359

Cited by 25 publications

(19 citation statements)

References 24 publications

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“…In our analyses, patients following the ROU protocol similarly experienced decreased time to regular diet, as well as faster return of bowel function and decreased time to ambulation. Given that increased opioid analgesic exposure is significantly correlated with postoperative ileus, increased time to first flatus, and time to tolerable oral diet, our result is not surprising [25]. Our LOS did not differ between cohorts, but was already 5.7 ± 0.3 days prior to the implementation of our intervention.…”

Section: Discussionmentioning

confidence: 54%

Implementation of a Reduced Opioid Utilization Protocol for Radical Cystectomy

Greenberg

Kee

Stevenson

et al. 2020

BLC

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BACKGROUND: Radical cystectomy (RC) often requires a prolonged course of opioid medications for postoperative pain management. We implemented a Reduced Opioid Utilization (ROU) protocol to decrease exposure to opioid medications. OBJECTIVE: To determine the impact of the ROU protocol on opioid exposure, pain control, inpatient recovery, and complication rates among patients who underwent RC. METHODS: The ROU protocol includes standardized recovery pathways, a multimodal opioid-sparing pain regimen, and improved patient and provider education regarding non-opioid medications. Opioid exposure was calculated as morphine equivalent dose (MED), and was compared between RC patients following the ROU protocol and patients who previously followed our traditional pathway. Opioid-related adverse drug events (ORADEs), pain scores, length of stay, and 90-day complications, readmission, and mortality were also compared between cohorts. RESULTS: 104 patients underwent RC, 54 (52%) of whom followed the ROU protocol. ROU patients experienced a statistically significant decrease in opioid exposure in the post-anesthesia care unit (p = 0.003) and during their postoperative recovery (85.7 ± 21.0 MED vs 352.6 ± 34.4 MED, p < 0.001). The ROU protocol was associated with a statistically significant decrease in ORADEs after surgery. There was no significant difference in average pain scores, length of stay, readmissions, or 90-day complication or mortality rates. CONCLUSIONS: The ROU protocol decreased opioid use by 77% without compromising pain control or increasing the rate of complications. This study demonstrates the efficacy of non-opioid medications in controlling postoperative pain, and highlights the role providers can play to decrease patient exposure to opioids after RC surgery.

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Section: Discussionmentioning

confidence: 54%

Implementation of a Reduced Opioid Utilization Protocol for Radical Cystectomy

Greenberg

Kee

Stevenson

et al. 2020

BLC

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“…Our results also demonstrated that the laparoscopic approach had predominance in the subgroup patients with higher risk of infection. In our study, laparoscopic operations were significantly more common among patients postoperatively using opioid analgesics which may inhibit peristalsis in the gut and increase the incidence of PPOI . The variable imbalance of opioid analgesics in the laparoscopic group was likely to contribute to the open group, which made our results more reliable.…”

Section: Discussionmentioning

confidence: 67%

“…In our study, laparoscopic operations were significantly more common among patients postoperatively using opioid analgesics which may inhibit peristalsis in the gut and increase the incidence of PPOI. 30,31 The variable imbalance of opioid analgesics in the laparoscopic group was likely to contribute to the open group, which made our results more reliable. In addition, lower postoperative potassium level was associated with the development of PPOI in elective colon resections.…”

Section: Discussionmentioning

confidence: 80%

Prolonged postoperative ileus in gastric surgery: Is there any difference between laparoscopic and open surgery?

Liang

Zhang

et al. 2019

Cancer Medicine

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Background Prolonged postoperative ileus (PPOI) is a common complication after abdominal surgery, but data about risk factors of PPOI for patients with gastric cancer are rare. We sought to investigate the impact of laparoscopic versus open surgery for PPOI after gastric cancer surgery. Methods A retrospective cohort study was conducted using a registry database consecutively collected from June 2016 to March 2017. PPOI was defined as no bowel function persisting for more than 4 days. Univariate analysis and multiple logistic regression models were performed to investigate risk factors, and stratified analysis was carried out to examine the primary association at different levels of a potential confounding factor. Results A total of 162 patients composed of 63 patients undergoing laparotomy and 99 patients undergoing laparoscopy were enrolled and PPOI was observed in 32 (19.75%) patients. Risk factors significantly correlated with PPOI were as follows: open surgery, older age, late surgical pathologic staging, postoperative use of opioid analgesic, low level of postoperative albumin and serum potassium. Compared to open surgery, the laparoscopic surgery was a strong protective factor for PPOI after adjusting related variables (OR = 0.17, CI: 0.05‐0.52, P = .002). There was an interaction between surgical methods and the postoperative WBC level (P for interaction = .007). In the two group stratified analysis of WBC, laparoscopic surgery had a significant lower risk of PPOI than open group for the patients with WBC counts above the middle level in crude or adjusted models. This result remained significantly in the three group stratified analysis for the patients with WBC counts in the middle and or high tertile groups. Conclusions PPOI is a common postoperative complication of patients after gastrectomy. Laparoscopic surgery is associated with decreased risk of PPOI in gastric surgery. Patients who underwent open surgery and presented with high level of WBC should be cautious with PPOI.

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“…Compared with open procedures, laparoscopic surgery is associated with less manipulation of bowel and use of opioid analgesia, which presumably will decrease the risk of gastrointestinal dysfunction [19]. In our case, we would expect an even lower rate of gastrointestinal complications, given that robotic surgery is associated with drastically reduced bowel manipulation and postoperative use of opiates compared with laparoscopic cases [20,21].…”

Section: Discussionmentioning

confidence: 77%