Standardizing Discharge Opioid Prescriptions in Kidney Transplant Patients Decreases Opioid Usage

Schwab, Marisa E.; Braun, Hillary J.; Quan, David; Roll, Garrett R.; Budanova, Nataliya; Ascher, Nancy L.; Hirose, Ryutaro

doi:10.1016/j.jss.2021.03.038

Cited by 4 publications

(11 citation statements)

References 14 publications

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“…Eleven studies evaluated the impact of a single opioid‐sparing medication including pregabalin, continuous systemic lidocaine, and local anesthetics (single and continuous dosing) 18,37–46 . Furthermore, seven studies evaluated the impact of a multimodal analgesic strategies, and two assessed the impact of different education‐based interventions 19–21,47–52 …”

Section: Resultsmentioning

confidence: 99%

“…Efficacy outcomes were variable, but generally included evaluation of opioid use and PRPS. Each comparative study demonstrated a statistically significant reduction in opioid use for those who received the various minimization intervention(s) 18–21,37–42,47–52 . Patient‐reported pain scales were also evaluated, but the impact of opioid minimization interventions varied by study 19,37,41,42,50 .…”

Section: Resultsmentioning

confidence: 99%

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A systematic review of opioid use and multimodal strategies in solid organ transplant recipients and living donors

et al. 2023

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The opioid epidemic has impacted analgesia in the postoperative period for solid organ transplant (SOT) donors and recipients. However, optimal pain management and opioid stewardship strategies have not been identified across this unique population. The purpose of this systematic review was to evaluate the impact of perioperative opioid use and to describe multimodal analgesic strategies to reduce opiate use in SOT recipients and living donors. A systematic review was conducted. Electronic searches were performed in Medline, Embase, Google Scholar, and Web of Science through December 31, 2021. Title and abstracts were screened. Relevant articles underwent full-text review. Literature was separated into effects of opioid exposure on post-transplant outcomes, recipient pain management strategies, and living donor pain management strategies. Search yielded 25,190 records, and 63 were ultimately included. The impact of opioid use on post-transplant outcomes was assessed in 19publications. The risk of graft loss in pretransplant opioid users was assessed in six reports and was found to be higher in the majority (66%) of publications. Opioid minimization strategies were reported in 20 studies in transplant recipients. Twenty-four studies evaluated pain management strategies in living donors. Both populations used a combination of multimodal strategies to minimize opioid use throughout the hospitalization and on discharge. Opioids are associated with select negative outcomes in post-transplant recipients. To minimize their use while also maintaining appropriate analgesia, multimodal pain regimens should be considered in SOT recipients and donors.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

A systematic review of opioid use and multimodal strategies in solid organ transplant recipients and living donors

et al. 2023

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“…Kutzler et al., Dualeh et al., Muir et al., and Schwab et al. found significant reductions in total outpatient MME use at varying timepoints post‐transplant ranging from 30 days to 6 months 4,18,20,22 . While Kutzler and colleagues found a difference in outpatient MME use in the liver transplant population, Tong et al.…”

Section: Discussionmentioning

confidence: 98%

“…In the kidney transplant population, Dualeh et al., Rohan et al., and Schwab et al. found the number of patients discharged on opioids to decrease by 48.3%, 91%, and 36.8%, respectively, with the implementation of their protocols 4,19,22 , . Kutzler et al., Dualeh et al., Muir et al., and Schwab et al.…”

Section: Discussionmentioning

confidence: 99%

“…The implementation of enhanced recovery after surgery (ERAS) protocols have improved post‐operative pain management by incorporating a multimodal, multidisciplinary approach. Patient education, utilization of multiple analgesics, and thoughtful discharge planning have all been demonstrated to reduce opioid use while achieving adequate post‐operative pain control 1–4 . While opioid reduction is not the primary goal of ERAS protocols, limiting opioid use and prescribing has both societal and individual patient benefits 5–7 …”

Section: Introductionmentioning

confidence: 99%

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Evaluation of a multidisciplinary, multimodal pain management protocol following pancreas transplantation

Lindner

Lakhani

Cooper

et al. 2022

Clinical Transplantation

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Introduction: Patients undergoing solid-organ transplantation demonstrate pain arising from both the surgical intervention and pre-existing comorbidities. High levels of opioid use both pre-and post-transplant are associated with unfavorable transplant outcomes. Patient education, multimodal therapy, and discharge planning have all been demonstrated to reduce opioid use after transplant.Methods: This is a single-center, retrospective study analyzing patients before and after implementation of a multimodal, multidisciplinary pain management protocol.Morphine milligram equivalents (MMEs) use during the index transplant hospitalization and the need for opioids at discharge was compared between the pre-and post-protocol groups.Results: A total of 52 patients were included in the study, 31 in the pre and 21 in the post-protocol groups. Inpatient MME use was reduced from 135.5 to 67.5 MMEs after protocol implementation. Additionally, the number of patients discharged on opioids following transplant decreased from 90.3% to 47.6%. Pain scores, length of stay (LOS), and return of bowel function was not different between groups. Conclusion:The implementation of a multimodal, multidisciplinary pain management protocol significantly decreased opioid use during the post-surgical hospitalization and in the 6 months following transplantation. A combination of non-opioid analgesics, patient education, and discharge planning can be beneficial elements in pancreas transplant pain management.

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Effectiveness of an Opioid Stewardship Guideline in Renal Transplant Recipients Post-Discharge

Berkley¹,

Takhar²,

Wilson³

et al. 2022

Journal of Pain & Palliative Care Pharmacotherapy

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Standardizing Discharge Opioid Prescriptions in Kidney Transplant Patients Decreases Opioid Usage

Cited by 4 publications

References 14 publications

A systematic review of opioid use and multimodal strategies in solid organ transplant recipients and living donors

A systematic review of opioid use and multimodal strategies in solid organ transplant recipients and living donors

Evaluation of a multidisciplinary, multimodal pain management protocol following pancreas transplantation

Effectiveness of an Opioid Stewardship Guideline in Renal Transplant Recipients Post-Discharge

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