Abstract
BackgroundOpioid sparing anesthesia and enhanced recovery after surgery protocols are not innovative ideas. However, the utilization of pancreaticoduodenectomy is limited. With the rise in awareness of the opioid epidemic in the United States, we have created a multimodal approach to anesthesia and postoperative care to limit adverse effects of opioids and curb the use of opioids postoperatively.MethodsWe conducted a retrospective cohort study performed by chart review of an opioid-sparing anesthetic and enhanced recovery after surgery (ERAS) protocol initiated jointly by the anesthesiology departments and transplant surgery for pancreaticoduodenectomy from January 2017 to October 2019.ResultsDemographic data was found to be comparable between the control and protocol groups. Hospital length of stay, ICU length of stay, and opioid requirements significantly decreased in the protocol group. Hospital length of stay decreased from 8.92 to 5.72 days, ICU days decreased from 1.52 to 0.42 days, and narcotics for the first five hospital days were significantly decreased from 130.13 to 71.2 morphine milligram equivalents.ConclusionProper postoperative pain management can improve patient satisfaction and decrease complication rates. Pancreaticoduodenectomy is a complicated procedure with relatively limited data regarding enhanced recovery after surgery protocols. Likewise, there is limited data regarding opioid-sparing anesthesia techniques. Our protocol produced promising hospital length of stay and reduced opioid administration during the first five hospital days without increasing 30-day readmission rates.
Highlights
Not a novel concept, Enhanced recovery after surgery (ERAS) programs have proven effective in reducing the surgical stress response leading to improved recovery and decreased hospital cost [1,2,3,4,5,6,7]
Though the benefits of ERAS were initially seen in colorectal surgery, ERAS protocols have been emerging in virtually all surgical subspecialties [1,2,3,4,5,6,7,8,9]
It has been suggested that the limited data and implementation of ERAS protocols for PD at institutions is due to the surgical complexity and mortality, and morbidity associated with the procedure [7]
Summary
Not a novel concept, Enhanced recovery after surgery (ERAS) programs have proven effective in reducing the surgical stress response leading to improved recovery and decreased hospital cost [1,2,3,4,5,6,7]. Despite published guidelines for pancreaticoduodenectomy (PD) by the ERAS society, there is relatively limited published data [10]. It has been suggested that the limited data and implementation of ERAS protocols for PD at institutions is due to the surgical complexity and mortality, and morbidity associated with the procedure [7]. Though morbidity and mortality have seen a decrease, the incidence of chronic opioid use postoperatively has continued to be of significant concern. With the rise in awareness of the opioid epidemic in the United States, we have created a multimodal approach to anesthesia and postoperative care to limit adverse effects of opioids and curb the use of opioids postoperatively
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