Pilot study of a novel pain management strategy: evaluating the impact on patient outcomes

Keller, DS; Tahilramani, RN; Flores-Gonzalez, JR; Ibarra, Sergio; Haas, EM

doi:10.1007/s00464-015-4459-4

Cited by 35 publications

(38 citation statements)

References 39 publications

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Section: Discussionmentioning

confidence: 68%

“…Studies of multimodal pain management in other postsurgical environments including liver resection have demonstrated patterns of similar or shortened recovery times and hospital lengths of stay relative to non-MPM strategies. 13,[25][26][27] We unexpectedly found that patients in the post-MPM group recovering from liver transplantation experienced longer hospitalizations as well as more time spent in the ICU relative to patients in the pre-MPM group. Although intraoperative transplant case duration and blood product use was similar between the groups, a trend toward a higher proportion of patients requiring reintubation and a numerically higher proportion of patients returning to the operating room in the post-MPM group was noted.…”

Section: Discussionmentioning

confidence: 99%

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Implementation of a Multimodal Pain Management Order Set Reduces Perioperative Opioid Use after Liver Transplantation

et al. 2019

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Study Objective Nonopioid strategies to optimize pain management in patients after liver transplantation remain underexplored. The purpose of this study was to evaluate whether the use of a multimodal pain management (MPM) order set would reduce postoperative opioid use in adult patients after liver transplantation. Design Retrospective pre– and post–order set implementation study. Setting Large academic tertiary care hospital. Patients Thirty‐one adults who underwent liver transplantation were included; of these, 18 received provider‐managed pain regimens (pre‐MPM group: August 20, 2016–January 17, 2018), and 13 received the MPM order set (post‐MPM group: January 18–July 31, 2018) after implementation of the order set on January 18, 2018. Measurements and Main Results The MPM order set included standardized receipt of acetaminophen 650 mg every 6 hours, gabapentin 300 mg every 8 hours (adjusted for renal function), and opioids for breakthrough pain. Patients managed with the MPM order set received, on average, 30.6 fewer opioid morphine milligram equivalents per day after final extubation than patients who did not receive MPM (median 16, interquartile range [IQR] 4.5–45.6 vs median 46.6, IQR 30.1–75.2; Mann‐Whitney U test, p=0.031). Although patients in the post‐MPM group had significantly worse renal function at baseline, no other statistically significant differences in baseline characteristics, pain scores, or prescribed outpatient opioids were noted between groups. Patients in the pre‐MPM group had a shorter intensive care unit and overall length of stay; however, patients in the post‐MPM group may have had more complex postoperative courses contributing to these differences. Conclusion Implementation of the MPM order set significantly reduced postoperative opioid use in liver transplant recipients. Our results provide a compelling rationale to further investigate the use of a non–opioid‐centered strategy to optimize pain management in patients recovering from liver transplantation, a population vulnerable to the risks of opioid use such as opioid use disorder, increased susceptibility to adverse effects, and poor allograft and survival outcomes.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Implementation of a Multimodal Pain Management Order Set Reduces Perioperative Opioid Use after Liver Transplantation

et al. 2019

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“… 107 A post-induction, pre-incision bilateral TAP block combined with local peritoneal infiltration at port sites with long-acting liposomal bupivacaine reduced initial and final PACU pain scores and shorten PACU times. 108 …”

Section: Regional Anesthesia Techniquesmentioning

confidence: 99%

Postoperative pain management in the postanesthesia care unit: an update

Luo

Min

2017

JPR

103

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Acute postoperative pain remains a major problem, resulting in multiple undesirable outcomes if inadequately controlled. Most surgical patients spend their immediate postoperative period in the postanesthesia care unit (PACU), where pain management, being unsatisfactory and requiring improvements, affects further recovery. Recent studies on postoperative pain management in the PACU were reviewed for the advances in assessments and treatments. More objective assessments of pain being independent of patients’ participation may be potentially appropriate in the PACU, including photoplethysmography-derived parameters, analgesia nociception index, skin conductance, and pupillometry, although further studies are needed to confirm their utilities. Multimodal analgesia with different analgesics and techniques has been widely used. With theoretical basis of preventing central sensitization, preventive analgesia is increasingly common. New opioids are being developed with minimization of adverse effects of traditional opioids. More intravenous nonopioid analgesics and adjuncts (such as dexmedetomidine and dexamethasone) are introduced for their opioid-sparing effects. Current evidence suggests that regional analgesic techniques are effective in the reduction of pain and stay in the PACU. Being available alternatives to epidural analgesia, perineural techniques and infiltrative techniques including wound infiltration, transversus abdominis plane block, local infiltration analgesia, and intraperitoneal administration have played a more important role for their effectiveness and safety.

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“…A recent meta-analysis showed that novel infiltration techniques such as wound catheter, TAP block, and intraperitoneal instillation led to a decrease in pain scores (32). TAP block was rarely applied in the present cohort, but might represent an alternative to conventional wound infiltration (5,33). Another reason for insufficient pain relief by wound infiltration might be a lack of proper follow-up with consequent insufficient administration of backup pain medication.…”

Section: Discussionmentioning

confidence: 79%

“…Enhanced recovery after surgery (ERAS) pathways advocate minimally invasive surgery to decrease surgical stress, morbidity, length of stay and costs (4). ERAS care protocols including multimodal pain management strategies aim to facilitate recovery by an opioidsparing attitude to avoid opioid-related side effects (5). Epidurals have been shown to be efficient after open surgery (6), and modern pain management strategies including intravenous lidocaine, wound infiltration or transverse abdominis plane (TAP) block emerge as alternatives for minimally invasive surgery (7).…”

Section: Introductionmentioning

confidence: 99%

Pain perception after colorectal surgery: A propensity score matched prospective cohort study

Grass¹,

Cachemaille²,

Martín³

et al. 2018

BST

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Pilot study of a novel pain management strategy: evaluating the impact on patient outcomes

Cited by 35 publications

References 39 publications

Implementation of a Multimodal Pain Management Order Set Reduces Perioperative Opioid Use after Liver Transplantation

Implementation of a Multimodal Pain Management Order Set Reduces Perioperative Opioid Use after Liver Transplantation

Postoperative pain management in the postanesthesia care unit: an update

Pain perception after colorectal surgery: A propensity score matched prospective cohort study

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