Association of Patient Controlled Analgesia and Total Inpatient Opioid Use After Pancreatectomy.

Abstract

The initial settings on an intravenous patient-controlled analgesia (IV-PCA) pump can represent a significant source of postoperative opioid exposure. The primary aim of this study was to evaluate the impact of first day IV-PCA use on total inpatient opioid use after open pancreatectomy, before and after standardization of initial dosing. Inpatient oral morphine equivalents (OMEs) were reviewed for pancreatectomy patients treated with IV-PCA at a single institution before and after (3/2016-8/2017 versus 3/2019-11/2020) implementation of a standardized initial IV-PCA dosing regimen (initial limit 0.1mg hydromorphone, or 1mg OME, every 10min as needed). IV-PCA OME in the first 24h and the total inpatient OME were compared between cohorts. Of 220 total patients, 132 were in the prestandardization (PRE) historical cohort. A first-24-h IV-PCA use was different (PRE median 95mg versus poststandardization [POST] 15mg, P<0.001). The median total inpatient OME was different (P<0.001) between PRE (525mg, interquartile range [IQR] 239-951mg) and POST patients (129mg, IQR 65-204mg) with 77% (median 373mg) of total inpatient OMEs contributed by IV-PCA in the PRE and 56% (median 64mg) in the POST cohorts. There were similar patient-reported pain scores between groups. Standardizing initial IV-PCA settings was associated with a reduced first-24-h opioid exposure, proportional and absolute total IV-PCA use, and total inpatient OMEs. Because of the contribution of an IV-PCA to the total inpatient opioid exposure, purposeful reduction or omission of an IV-PCA is critical to perioperative opioid reduction strategies.