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Optimization of an Enhanced Recovery After Surgery protocol for opioid-free pain management following robotic thoracic surgery

OBJECTIVES: Our Enhanced Recovery After Thoracic Surgery protocol was implemented on February 1, 2018, and firmly established 7 months later. We instituted protocol modifications on January 1, 2020, aiming to further reduce postoperative opioid consumption. We sought to evaluate the influence of suc...

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Autores principales: Kodia, Karishma, Alnajar, Ahmed, Szewczyk, Joanne, Stephens-McDonnough, Joy, Villamizar, Nestor R., Nguyen, Dao M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9390316/
https://www.ncbi.nlm.nih.gov/pubmed/36003463
http://dx.doi.org/10.1016/j.xjon.2021.09.051
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author Kodia, Karishma
Alnajar, Ahmed
Szewczyk, Joanne
Stephens-McDonnough, Joy
Villamizar, Nestor R.
Nguyen, Dao M.
author_facet Kodia, Karishma
Alnajar, Ahmed
Szewczyk, Joanne
Stephens-McDonnough, Joy
Villamizar, Nestor R.
Nguyen, Dao M.
author_sort Kodia, Karishma
collection PubMed
description OBJECTIVES: Our Enhanced Recovery After Thoracic Surgery protocol was implemented on February 1, 2018, and firmly established 7 months later. We instituted protocol modifications on January 1, 2020, aiming to further reduce postoperative opioid consumption. We sought to evaluate the influence of such efforts on clinical outcomes and the use of both schedule II and schedule IV opioids following robotic thoracoscopic procedures. METHODS: A retrospective study of patients undergoing elective robotic procedures between September 1, 2018, and December 31, 2020, was conducted. Essential components of pain management in the original protocol included nonopioid analgesics, intercostal nerve blocks with long-acting liposomal bupivacaine diluted with normal saline, and opioids (ie, scheduled tramadol administration and as-needed schedule II narcotics). Protocol optimization included replacing saline diluent with 0.25% bupivacaine and switching tramadol to as needed, keeping other aspects unchanged. Demographic characteristics, type of robotic procedures, postoperative outcomes, and in-hospital and postdischarge opioids prescribed (ie, milligrams of morphine equivalent [MME]) were extracted from electronic medical records. RESULTS: Three hundred twenty-four patients met the inclusion criteria (159 in the original and 183 in the optimized protocol). There was no difference in postoperative outcomes or acute postoperative pain; there was a significant reduction of in-hospital and postdischarge opioid requirements in the optimized cohort. For anatomic resections: mean, 60.0 MME (range, 0-60.0 MME) versus mean, 105.0 MME (range, 60.0-150.0 MME), and other procedures: mean, 0 MME (range, 0-60 MME) versus mean, 140.0 (range, 60.0-150.0 MME) (P < .00001) with median schedule II opioids prescribed = 0. CONCLUSIONS: Small modifications to our protocol for pain management strategies are safe and associated with significant decrease of opioid requirements, particularly schedule II narcotics, during the postoperative period without influencing acute pain levels.
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spelling pubmed-93903162022-08-23 Optimization of an Enhanced Recovery After Surgery protocol for opioid-free pain management following robotic thoracic surgery Kodia, Karishma Alnajar, Ahmed Szewczyk, Joanne Stephens-McDonnough, Joy Villamizar, Nestor R. Nguyen, Dao M. JTCVS Open Thoracic: Perioperative Management OBJECTIVES: Our Enhanced Recovery After Thoracic Surgery protocol was implemented on February 1, 2018, and firmly established 7 months later. We instituted protocol modifications on January 1, 2020, aiming to further reduce postoperative opioid consumption. We sought to evaluate the influence of such efforts on clinical outcomes and the use of both schedule II and schedule IV opioids following robotic thoracoscopic procedures. METHODS: A retrospective study of patients undergoing elective robotic procedures between September 1, 2018, and December 31, 2020, was conducted. Essential components of pain management in the original protocol included nonopioid analgesics, intercostal nerve blocks with long-acting liposomal bupivacaine diluted with normal saline, and opioids (ie, scheduled tramadol administration and as-needed schedule II narcotics). Protocol optimization included replacing saline diluent with 0.25% bupivacaine and switching tramadol to as needed, keeping other aspects unchanged. Demographic characteristics, type of robotic procedures, postoperative outcomes, and in-hospital and postdischarge opioids prescribed (ie, milligrams of morphine equivalent [MME]) were extracted from electronic medical records. RESULTS: Three hundred twenty-four patients met the inclusion criteria (159 in the original and 183 in the optimized protocol). There was no difference in postoperative outcomes or acute postoperative pain; there was a significant reduction of in-hospital and postdischarge opioid requirements in the optimized cohort. For anatomic resections: mean, 60.0 MME (range, 0-60.0 MME) versus mean, 105.0 MME (range, 60.0-150.0 MME), and other procedures: mean, 0 MME (range, 0-60 MME) versus mean, 140.0 (range, 60.0-150.0 MME) (P < .00001) with median schedule II opioids prescribed = 0. CONCLUSIONS: Small modifications to our protocol for pain management strategies are safe and associated with significant decrease of opioid requirements, particularly schedule II narcotics, during the postoperative period without influencing acute pain levels. Elsevier 2022-01-25 /pmc/articles/PMC9390316/ /pubmed/36003463 http://dx.doi.org/10.1016/j.xjon.2021.09.051 Text en © 2022 The Author(s) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Thoracic: Perioperative Management
Kodia, Karishma
Alnajar, Ahmed
Szewczyk, Joanne
Stephens-McDonnough, Joy
Villamizar, Nestor R.
Nguyen, Dao M.
Optimization of an Enhanced Recovery After Surgery protocol for opioid-free pain management following robotic thoracic surgery
title Optimization of an Enhanced Recovery After Surgery protocol for opioid-free pain management following robotic thoracic surgery
title_full Optimization of an Enhanced Recovery After Surgery protocol for opioid-free pain management following robotic thoracic surgery
title_fullStr Optimization of an Enhanced Recovery After Surgery protocol for opioid-free pain management following robotic thoracic surgery
title_full_unstemmed Optimization of an Enhanced Recovery After Surgery protocol for opioid-free pain management following robotic thoracic surgery
title_short Optimization of an Enhanced Recovery After Surgery protocol for opioid-free pain management following robotic thoracic surgery
title_sort optimization of an enhanced recovery after surgery protocol for opioid-free pain management following robotic thoracic surgery
topic Thoracic: Perioperative Management
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9390316/
https://www.ncbi.nlm.nih.gov/pubmed/36003463
http://dx.doi.org/10.1016/j.xjon.2021.09.051
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