Postdischarge Pain and Opioid Use After Cardiac Surgery: A Prospective Cohort Study

Percy, Edward; Hirji, Sameer; Leung, Nick; Harloff, Morgan; Newel, Paige; Cherkasky, Olena; McGurk, Siobhan; Yazdchi, Farhang; Cook, R.C.M.; Pelletier, Marc; Kaneko, Tsuyoshi

doi:10.1016/j.athoracsur.2021.12.007

Cited by 3 publications

(1 citation statement)

References 32 publications

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“…Recommendations for pain management after discharge from cardiac surgery are still evolving. Some studies indicate 30% to 50% of patients do not use opioids on discharge (Brescia et al, 2021; Percy et al, 2023; Wagner et al, 2022). Several expert groups recommend limiting the number of pills prescribed at discharge to 20–25 tablets (Brescia et al, 2021; Overton et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Implementing an evidence-based guideline to decrease opioids after cardiac surgery

Galao-Malo,

Davidson,

D'Aoust

et al. 2024

J Am Assoc Nurse Pract

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Background: Deaths related to overdoses continue growing in the United States. The overprescription of opioids after surgical procedures may contribute to this problem. Local problem: There is inconsistency in the prescription of opioids in cardiovascular surgery patients. Recommendations regarding the reduction of opioids at discharge are not fully implemented. Methods: This is a single-center, pre–post quality improvement project in adult patients after elective cardiac surgery through sternotomy. Interventions: Changes in guidelines, modification of order sets, creation of dashboards, and education to the providers to increase the prescription of acetaminophen around the clock on the step-down unit and at discharge, decrease the number of opioid tablets to 25 or less at discharge and decrease the prescription of opioids to 25 or less morphine milligram equivalents (MME) at discharge. Results: The preintervention group included 67 consecutive patients who underwent cardiac surgery from November to December 2021. The postintervention group had 67 patients during the same period in 2022. Acetaminophen prescription on the step-down unit increased from 9% to 96% (p < .001). The proportion of patients discharged with 25 or less opioid tablets increased from 18% to 90% (p < .001) and with 25 or less MME from 30% to 55% (p < .01). Acetaminophen prescription at discharge increased from 10% to 48% (p < .001). Conclusions: Our intervention increased the use of acetaminophen and decreased the overprescription of opioids in cardiac surgery patients at discharge. Further research is necessary to continue improving pain management to reduce the number of opioids prescribed at discharge.

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Section: Introductionmentioning

confidence: 99%

Implementing an evidence-based guideline to decrease opioids after cardiac surgery

Galao-Malo,

Davidson,

D'Aoust

et al. 2024

J Am Assoc Nurse Pract

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Predicting Extent of Opioid Use Following Cardiac Surgery: A Pilot Study

Kertai,

Rayl,

Larach

et al. 2024

Journal of Cardiothoracic and Vascular Anesthesia

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Pharmacokinetics of Methadone in Adult Patients Undergoing Cardiac Surgery With Cardiopulmonary Bypass

Salas,

Cortinez,

López

et al. 2024

Anesthesia &Amp; Analgesia

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BACKGROUND: Cardiopulmonary bypass (CPB) induces profound physiological changes that may alter the pharmacokinetics of methadone. We aimed to describe the pharmacokinetics of an intravenous bolus of methadone racemate in adult patients undergoing heart surgery with CPB. METHODS: We prospectively studied 29 patients aged 45 to 75 years scheduled for cardiac surgery with CPB who received methadone 0.2 mg/kg after anesthesia induction. Arterial blood samples (n = 10) were taken, before, during, and after CPB. Pharmacokinetic analysis was undertaken using nonlinear mixed effects models. RESULTS: All patients completed the study. The median [interquartile range] methadone concentrations decreased from 34.8 [23.9–48.2] ng/mL (10 minutes before CPB) to 18.2 [9.9–26] ng/mL after 60 minutes of CPB (P < .001). A 3-compartment model adequately described the observed changes in methadone concentrations. The influence of CPB on methadone pharmacokinetics was best described by hemodilution in a fixed volume of 1.5 L (CPB circuit volume) and by sequestration from the CPB components (CLSEQ = 93.4 L/h, 95%CI 59–124, P < .01). The observed effect of CPB in methadone pharmacokinetics can be compensated by giving a supplementary bolus dose of 0.05 mg/kg at the end of CPB. CONCLUSIONS: Our results confirmed a decay in methadone concentrations during CPB, which, in our modeling analysis, was attributed to hemodilution and sequestration within the CPB components.

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Postdischarge Pain and Opioid Use After Cardiac Surgery: A Prospective Cohort Study

Cited by 3 publications

References 32 publications

Implementing an evidence-based guideline to decrease opioids after cardiac surgery

Implementing an evidence-based guideline to decrease opioids after cardiac surgery

Predicting Extent of Opioid Use Following Cardiac Surgery: A Pilot Study

Pharmacokinetics of Methadone in Adult Patients Undergoing Cardiac Surgery With Cardiopulmonary Bypass

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