Postoperative opioid prescription patterns and new opioid refills following cardiac implantable electronic device procedures

Lee, Justin Z.; Pasha, Ahmed K.; Glasgow, Amy E.; Habermann, Elizabeth B.; Kusumoto, Fred; McLeod, Christopher J.; Goel, Vasudha; Sorajja, Dan; Srivathsan, Komandoor; Shen, Win Kuang; Madhavan, Malini; Deshmukh, Abhishek; Mei, Yong; Friedman, Paul A.; Asirvatham, Samuel J.; Mulpuru, Siva K.

doi:10.1016/j.hrthm.2019.08.011

Cited by 17 publications

(17 citation statements)

References 31 publications

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“…Patients who underwent subcutaneous ICD had the highest rate of postoperative opioid prescriptions among all cardiac implantable electronic device procedures 2 . This is likely because of the larger device footprint of the subcutaneous ICD.…”

Section: Discussionmentioning

confidence: 99%

“…However, with the larger device footprint and with implantation technique that requires a larger pocket and subcutaneous tunneling, patients may experience more pain compared to transvenous ICD procedures. Among all cardiac device procedures, S‐ICD had the highest rate of postoperative opioid prescription 2 . The management of pain after subcutaneous implantable cardioverter defibrillation implantation poses a special challenge to the cardiac electrophysiologist.…”

Section: Introductionmentioning

confidence: 99%

“…Among all cardiac device procedures, S-ICD had the highest rate of postoperative opioid prescription. 2 The management of pain after subcutaneous implantable cardioverter defibrillation implantation poses a special challenge to the cardiac electrophysiologist.…”

Section: Introductionmentioning

confidence: 99%

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Liposomal bupivacaine during subcutaneous implantable cardioverter defibrillator implantation for pain management

Lee

Glasgow

Habermann

et al. 2021

Pacing Clinical Electrophis

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Background The subcutaneous implantable cardioverter‐defibrillator (S‐ICD) has a larger generator and its implantation involves more dissection and tunneling compared to traditional transvenous defibrillator system. Liposomal bupivacaine, an extended‐release bupivacaine with 72 h of duration has been used for postoperative pain management in patients undergoing S‐ICD implantation. Our aim was to compare postoperative pain and opioid prescription patterns among patients undergoing S‐ICD implantation who received intraprocedural liposomal bupivacaine and those who did not. Methods We performed a retrospective analysis of all patients who underwent subcutaneous ICD implantation from January 1, 2013 to March 30, 2018 at the Mayo Clinic in Rochester, Minnesota. Patients were categorized into those who received liposomal bupivacaine and those who did not. Data on inpatient pain score, outpatient opioid prescription rates at discharge, and doses based on oral morphine equivalents (OME) were collected. Results A total of 104 patients underwent S‐ICD implantation. Intraprocedural liposomal bupivacaine was used in 69% of patients. Patients who received intraprocedural liposomal bupivacaine had similar mean inpatient pain scores (2.9 vs. 2.9, p = .786). There was also no difference in the rate of inpatient opioid administration (79.2% vs. 87.5%, p = .4139), outpatient opioid prescription (23.6% vs. 12.5%, p = .29), or mean OME (41.7‐mg vs. 16.6‐mg, p = .188) when comparing patients those who received intraprocedural liposomal bupivacaine and those who did not. Conclusion Intraprocedural liposomal bupivacaine administration was not associated with any significant impact on postoperative pain scores, inpatient opioid administration, and outpatient opioid prescription rates or OME amounts at discharge.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Liposomal bupivacaine during subcutaneous implantable cardioverter defibrillator implantation for pain management

Lee

Glasgow

Habermann

et al. 2021

Pacing Clinical Electrophis

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“…In a study of opioid use following CIED implantations, patients who underwent subcutaneous ICD implantation were more likely to be prescribed opioids than those implanted with transvenous devices (25% vs. 20%) [17]. In a retrospective single-center study of structured interviews with female patients who were implanted with a subcutaneous ICD (mean time since implant 4.6 ± 3.1 years) 54% said their postsurgical pain was worse than they expected [18].…”

Section: Subcutaneous Icdsmentioning

confidence: 99%

“…In an analysis of opioid prescribing for CIED implantation, patients undergoing device upgrades and generator change-outs were less likely to receive opioids than those getting a de novo implant (18.3%, 11.6%, and 20%, respectively) [17].…”

Section: Device Revisionmentioning

confidence: 99%

Postoperative Pain Control Following Cardiac Implantable Electronic Device Implantation

Magnusson¹,

LeQuang²,

Pergolizzi³

2022

Cardiac Rhythm Management - Pacing, Ablation, Devices

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Postoperative pain following cardiac implantable electronic device (CIED) surgery may not always be adequately treated. The postoperative pain trajectory occurs over several days following the procedure with tenderness and limited arm range of motion lasting for weeks after surgery. Pain control typically commences in the perioperative period while the patient is in the hospital and may continue after discharge; outpatients may be given a prescription and advice for their analgesic regimen. It is not unusual for CIED patients to be discharged a few hours after implantation. While opioids are known as an effective analgesic to manage acute postoperative pain, growing scrutiny on opioid use as well as their side effects and potential risks have limited their use. Opioids may be considered for appropriate patients for a short course of treatment of acute postoperative pain, but other analgesics may likewise be considered.

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Postoperative intravenous patient‐controlled analgesia improves pain management after subcutaneous implantable defibrillator implantation

Tsutsui,

Terazaki,

Kanai

et al. 2024

Journal of Arrhythmia

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ObjectivePostoperative pain is a major issue with subcutaneous implantable cardioverter defibrillators (S‐ICD). In 2020, we introduced intravenous patient‐controlled analgesia (IV‐PCA) in addition to the conventional, request‐based analgesia for postoperative pain control in S‐ICD. To determine the effect and safety, we quantitatively assessed the effect of IV‐PCA after S‐ICD surgery over conventional methods.MethodsDuring the study period, a total of 113 consecutive patients (age, 50.1 ± 15.5 years: males, 101) underwent a de novo S‐ICD implantation under general anesthesia. While the postoperative pain was addressed with either request‐based analgesia (by nonsteroid anti‐inflammatory drugs, N = 68, dubbed as “PCA absent”) or fentanyl‐based IV‐PCA in addition to the standard care (N = 45, dubbed as “PCA present”). The degree of postoperative pain from immediately after surgery to 1 week were retrospectively investigated by the numerical rating scale (NRS) divided into four groups at rest and during activity (0: no pain, 1–3: mild pain, 4–6: moderate pain, 7–10: severe pain).ResultsAlthough IV‐PCA was removed on Day 1, it was associated with continued better pain control compared to PCA absent group. At rest, the proportion of patients expressing pain (mild or more) was significantly lower in the PCA present group from Day 0 to Day 4. In contrast to at rest, a better pain control continued through the entire study period of 7 days. No serious adverse events were observed. A few patients experienced nausea in both groups and the inter‐group difference was not found significant.ConclusionIV‐PCA suppresses postoperative pain in S‐ICD without major safety concerns.

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Postoperative opioid prescription patterns and new opioid refills following cardiac implantable electronic device procedures

Cited by 17 publications

References 31 publications

Liposomal bupivacaine during subcutaneous implantable cardioverter defibrillator implantation for pain management

Liposomal bupivacaine during subcutaneous implantable cardioverter defibrillator implantation for pain management

Postoperative Pain Control Following Cardiac Implantable Electronic Device Implantation

Postoperative intravenous patient‐controlled analgesia improves pain management after subcutaneous implantable defibrillator implantation

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