Opioid Consumption In Patients Research Articles

Opioid Sparing Multimodal Analgesia for Transoral Robotic Surgery: Improved Analgesia and Narcotic Use Reduction.

To compare postoperative pain scores and opioid consumption in patients after transoral robotic surgery (TORS). Single institution retrospective cohort study. TORS was performed at a single academic tertiary care center. This study compared traditional opioid-based and opioid-sparing multimodal analgesia (MMA) regimens in patients with oropharyngeal and supraglottic malignancy after TORS. Data were obtained from the electronic health records from August 2016 to December 2021. The average postoperative pain scores and total opioid consumption in morphine milligram equivalents were calculated for postoperative days (PODs) 0 to 3. The secondary objectives were to quantify and characterize opioid prescriptions upon hospital discharge. A total of 114 patients were identified for this study, 58 patients in the non-MMA cohort and 56 in the MMA cohort. Postoperative pain levels in the MMA cohort were statistically lower on POD 0 (p = 0.001), POD 1 (p = 0.001), and POD 3 (p = 0.004). Postoperative opioid consumption decreased significantly in the MMA cohort from 37.7 to 10.8 mg on POD 0 (p = 0.002), 65.9 to 19.9 mg on POD 1 (p < 0.001), 36.0 to 19.3 mg on POD 2 (p = 0.02), and 45.4 to 13.8 mg on POD 3 (p = 0.02). The number of patients discharged from the hospital with a prescription for narcotics was significantly lower in the MMA cohort (71.4%) compared with the non-MMA cohort (98.3%) (p < 0.001). Implementation of our MMA pain protocol reduced pain levels and narcotic consumption in the immediate postoperative period.

Effects of ultrasound-guided regional anesthesia in cardiac surgery: a systematic review and network meta-analysis

BackgroundThe objective of this systematic review and network meta-analysis was to compare the effects of single-shot ultrasound-guided regional anesthesia techniques on postoperative opioid consumption in patients undergoing open cardiac surgery.MethodsThis systematic review and network meta-analysis involved cardiac surgical patients (age > 18 y) requiring median sternotomy. We searched PubMed, EMBASE, The Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Web of Science. The effects of the single-shot ultrasound-guided regional anesthesia technique were compared with those of placebo and no intervention. We conducted a risk assessment of bias for eligible studies and assessed the overall quality of evidence for each outcome.ResultsThe primary outcome was opioid consumption during the first 24 h after surgery. The secondary outcomes were pain after extubation at 12 and 24 h, postoperative nausea and vomiting, extubation time, intensive care unit discharge time, and length of hospital stay. Fifteen studies with 849 patients were included. The regional anesthesia techniques included pecto-intercostal fascial block, transversus thoracis muscle plane block, erector spinae plane (ESP) block, and pectoralis nerve block I. All the regional anesthesia techniques included significantly reduced postoperative opioid consumption at 24 h, expressed as morphine milligram equivalents (MME). The ESP block was the most effective treatment (-22.93 MME [-34.29;-11.56]).ConclusionsIn this meta-analysis, we concluded that fascial plane blocks were better than placebo when evaluating 24 h MMEs. However, it is still challenging to determine which is better, given the paucity of studies available in the literature. More randomized controlled trials are required to determine which regional anesthesia technique is better.Trial registrationPROSPERO; CRD42022315497.

Transcutaneous electrical acupoint stimulation to reduce opioid consumption in patients undergoing inguinal hernia repair: protocol for a randomized controlled trial

BackgroundThe purpose of this study is to evaluate the efficacy and safety of transcutaneous electrical acupoint stimulation (TEAS) in the postoperative treatment of patients undergoing inguinal hernia repair compared with sham and no treatment group.MethodsThis study is a protocol for a three-armed, single-blinded, placebo-controlled randomized controlled trial. Ninety participants scheduled for inguinal hernia repair will be randomly assigned to the TEAS group (n = 30), sham group (n = 30), and control group (n = 30). The TEAS group will receive treatment using four portable coin-sized electro-stimulators at both local and distal acupuncture points. The sham group will receive sham treatment with mock electrostimulation. The treatment groups will receive mixed frequency stimulation (alternating at 2 and 100 Hz every 3 s) in continuous mode for 30 min at intervals of 2 h for 24 h postoperatively. The control group will receive postoperative pain control using patient-controlled analgesia (PCA) device. The primary outcome is the total morphine dose received in the postoperative period (mg) using PCA 24 h after surgery. The number of PCA demands (i.e., times the button will be pressed) and delivered bolus doses, score on the Visual Analogue Scale, opioid-related side effects, the requirement for supplemental medications, score on the Hospital Anxiety and Depression Scale (HADS), and blood levels of stress hormones cortisol and prolactin.DiscussionThe results of this trial will determine whether TEAS with intensified stimulation protocol is a safe and effective option for reducing analgesic consumption and postoperative pain.Trial registrationISRCTN76428396. Registered on 05 October 2020. https://www.isrctn.com/ISRCTN76428396

Canadian Spine Society

# Abstract 57. Radiographic reporting in adolescent idiopathic scoliosis: Is there a discrepancy comparing radiologists’ reports and surgeons’ assessments? {#article-title-2} Cobb angle measurement is the standard method for quantification of scoliosis in adolescent idiopathic scoliosis (AIS),

Pre-operative short-term pranayama (yoga) decreases intraoperative opioid consumption in patients undergoing on-pump cardiac surgery.

Pre-operative short-term pranayama (yoga) decreases intraoperative opioid consumption in patients undergoing on-pump cardiac surgery.

Frequency and Predictors of Opioid Use in Rheumatoid Arthritis and Seronegative Spondyloarthropathy Patients.

Pain is one of the most challenging symptoms in patients with rheumatoid arthritis (RA) and spondyloarthropathies (SpAs), and pain relief is one of the top priorities for improving health-related quality of life. When medication therapy does not significantly reduce pain, chronic opioid consumption becomes more prominent in such patients. This study aimed to evaluate the state of opioid use in RA and SpA patients. This cross-sectional study was performed on 316 patients with RA and spondyloarthropathies (SpAs) from January to March 2014. The convenience sampling method was used to select the participants, and by obtaining verbal consent, everyone was given 15 minutes to complete a checklist independently. Demographic and opioid use data were evaluated in terms of opioid use and its predictors. In this regard, univariate and multivariate logistic regressions were used to evaluate the predictors of opioid consumption in patients. All analyses were conducted using SPSS 21 and the significance level was set at P<0.05. About 9.5% of all participants, including 8.8% of RA and 22.6% of SpA cases, were opioid abusers. In the first step of the analysis, it was observed that opioid abuse was significantly higher in men, married participants, urban residents, patients with no biological therapy, and patients with a negative family history of addiction. The most prevalent ways of drug abuse were smoking and ingestion. The results of univariate logistic regression analysis revealed SpA and other factors significantly increase the chance of opioid abuse. Furthermore, multivariate logistic regression analysis showed male gender (OR=10.4) and negative family history of addiction (OR=3.19) significantly affected addiction in RA and SpA patients with a 95% confidence interval. Lack of suitable responsiveness to medication therapy to relieve pain, inconsistent pain evaluation, and shame of asking direct questions about addiction in RA and SpA patients may lead to opioid consumption in some cases. Seronegative SpA may make patients more prone to addiction. However, in this study, male gender and no family history of addiction were related to opioid abuse.

Continuous Ropivacaine Peroneal Nerve Infiltration for Fibula Free Flap in Cervicofacial Cancer Surgery: A Randomized Controlled Study.

Introduction: Pain after cervicofacial cancer surgery with free flap reconstruction is both underestimated and undertreated. There is a rational for regional anesthesia at the flap harvest site, but few studies describe it. We assessed the influence of common peroneal nerve infiltration on pain and opioid consumption in patients having oropharyngeal cancer surgery with fibular free flap mandibular reconstruction. Methods: After institutional review board (IRB) approval and written informed consent, fifty-six patients were randomly allocated to perineural catheter with ropivacaine infiltration (ROPI) or systemic analgesia (CONTROL). In the ROPI group, an epidural catheter was placed by the surgeon before closure, and ropivacaine 0.2% 15 mL, followed by 4 mL/h during 48 h, was administered. The primary outcomes were pain scores and morphine consumption during the 48 h postoperative period. We also measured ropivacaine concentration at the end of infusion. Finally, we retrospectively assessed long-term pain up to 10 years using electronic medical charts. Results: Perineural infiltration of ropivacaine significantly reduced pain scores at the harvest site only at day 1, and did not influence overall postoperative opioid consumption. Ropivacaine assay showed a potentially toxic concentration in 50% of patients. Chronic pain was detected at the harvest site in only one patient (ROPI group), and was located in the cervical area in the case of disease progression. Discussion: Although the catheter was visually positioned by the surgeon, continuous ropivacaine infiltration of the common peroneal nerve did not significantly reduce postoperative pain, but induced a blood concentration close to the toxic threshold at day 2. Further studies considering other infiltration locations or other dosing schemes should be tested in this context, both to improve efficacy and reduce potential toxicity.

The efficacy and safety of an adapted opioid-free anesthesia regimen versus conventional general anesthesia in gynecological surgery for low-resource settings: a randomized pilot study

IntroductionThere is scarce data on the safety and efficacy of opioid-free anesthesia (OFA), in resource-limited settings due to the non-availability of dexmedetomidine, the reference OFA agent. We aimed to demonstrate the feasibility, efficacy and safety of a practical OFA protocol not containing dexmedetomidine, adapted for low-resource environments in very painful surgeries like gynecological surgery.MethodsWe conducted a randomized pilot study on ASA I and II women undergoing elective gynecological surgery at a tertiary care hospital in Cameroon. Patients were matched in a ratio of 1:1 into an OFA and a conventional general anesthesia (CGA) group. The OFA protocol entailed the intravenous (IV) magnesium sulfate, lidocaine, ketamine, dexamethasone, propofol, and rocuronium, followed by isoflurane and a continuous infusion of a calibrated mixture of magnesium sulfate, ketamine and clonidine. The CGA protocol was IV dexamethasone, diazepam, fentanyl, propofol, and rocuronium, followed by isoflurane and reinjections of fentanyl propofol and a continuous infusion of normal saline as placebo. The primary endpoints were the success rate of OFA, isoflurane consumption and intraoperative anesthetic complications. The secondary endpoints were postoperative pain intensity, postoperative complications, patient satisfaction assessed using the QoR-40 questionnaire and the financial cost of anesthesia.ResultsWe enrolled a total of 36 women undergoing gynecological surgery; 18 in the OFA group and 18 in the CGA group. The success rate of OFA was 100% with significant lesser consumption of isoflurane in the OFA group, no significant intraoperative complication and better intraoperative hemodynamic stability in the OFA group. Postoperatively, compared to the CGA group, the OFA group had statistically significantly less pain during the first 24 h, no morphine consumption for pain relief, had less hypoxemia during the first six hours, less paralytic ileus, less nausea and vomiting, no pruritus and better satisfaction. The mean financial cost of this adapted OFA protocol was statistically significant lesser than that of CGA.ConclusionThis OFA regimen without dexmedetomidine for a low-resource setting has a promising success rate with few perioperative complications including mild intraoperative hemodynamic changes, decrease postoperative complications, pain, and opioid consumption in patients undergoing elective gynecology surgery.Trial registrationThis study was registered at clinicaltrials.gov on 03/02/2021 under the registration number NCT04737473.

An Educational Mobile Application to Improve Patient Engagement and Decrease Postoperative Opioid Consumption in Patients Undergoing Elective Colorectal Surgery

Introduction: Mobile applications offer innovative opportunities for patient engagement and preoperative education. Among patients undergoing elective colorectal surgery, we evaluated the impact of patient enrollment in an interactive mobile app on perioperative enhanced recovery after surgery (ERAS) metric completion rates, postoperative opioid consumption, and length of stay. Methods: Data were prospectively collected on consecutive patients undergoing elective colorectal surgery managed on standard ERAS protocols. Enrolled mobile app patients received daily electronic reminders and educational material starting 7 days preoperatively through 30 days post-discharge. Patients not enrolled in the app received surgeon-specific education at preoperative clinic appointments. Perioperative clinicopathologic variables were collected, including ERAS metric completion rates. Daily postoperative morphine milligram equivalents (MME) requirements were analyzed. Results: A total of 111 patients enrolled in the mobile app, while 58 did not enroll (designated “non-users”). No significant differences in demographics, procedure, approach, or ostomy creation (all p >0.20) were noted. More mobile app users had a cancer diagnosis (68% vs 38%; p = 0.002). Mobile app users demonstrated increased rates of preoperative antibiotic completion (81% vs 73%) and preoperative clear liquid carbohydrate loading (88% vs 71%). Daily MME requirements were not significantly lower for app users on postoperative day (POD) 0, POD1, or POD2. Median LOS was 3 days in both cohorts. The 30-day readmission rate was lower among app users (6% vs 14%; p = 0.10). Conclusion: Enrollment of patients undergoing elective colorectal surgery in a mobile education app was associated with non-significantly increased rates of ERAS metric completion and decreased 30-day readmission rates. Postoperative narcotic use was not significantly impacted.

Opioid consumption and pain in patients with gynecological cancer who underwent spinal anesthesia vs. general anesthesia for interstitial brachytherapy

AIMSInterstitial brachytherapy (ISBT) is an effective option for delivering conformal high dose radiation to the target volume with better organ-at risk sparing but is thought to be more invasive and painful than other methods. This study investigated pain levels and opioid consumption in patients who received spinal anesthesia (SA) or general anesthesia (GA) for their ISBT. MATERIALS AND METHODSPatients that underwent ISBT from April 2014 to September 2018 were analyzed from a prospective institutional database. The most prevalent malignancies were cervical (45%), recurrent endometrial (27%) and vaginal (20%) cancers. Baseline patient characteristics, radiation treatment details, anesthesia records, and inpatient charts were obtained. Opioid consumption was quantified as oral morphine equivalent per day (OMEq/day) from implantation until removal. Pain score levels were collected by using an 11-point scoring system. RESULTSNinety nine patients received GA and 40 patients received SA as their anesthesia for ISBT. During their first admission, 76 patients (55%) required intravenous opioids. Patients receiving SA had significantly lower mean pain scores on the morning of their procedure 6 (Interquartile range [IQR] 2–8) vs. 0 (IQR: 0–1); p < 0.001]. Pain did not significantly differ between cohorts at any other time. During the first admission, SA patients had a lower median opioid usage of 23 (IQR: 9–47) mg/day compared to GA patients at 38 (IQR: 21–71) mg/day (p = 0.011). No difference in opioid consumption was seen during subsequent admissions. CONCLUSIONSIn patients undergoing ISBT, SA provides better immediate pain control post insertion compared to GA. Patients who received SA used lower amounts of opioids during their first ISBT insertion.

PO143 / #288 EFFECTS OF 10 KHZ SPINAL CORD STIMULATION ON PAIN AND OPIOID CONSUMPTION IN CHRONIC NEUROAXIS AND/OR EXTREMITY PAIN: A RETROSPECTIVE REVIEW: E-POSTER VIEWING

Long-term opioid therapy remains a common treatment for patients with chronic pain, despite a lack of supporting evidence.1Given the risk of serious harms associated with long-term opioid use,2 alternative pain relief therapies that can reduce or eliminate opioids are required. The aim of this retrospective review was to evaluate the effect of 10 kHz spinal cord stimulation (SCS) on pain and opioid consumption in patients with chronic neuroaxis and/or extremity pain treated at the Lawrence + Memorial Hospital (L+MH), New London, CT.

Rapid recovery pathway without epidural catheter analgesia for surgical treatment of adolescent idiopathic scoliosis: a comparative study.

To assess effectiveness of a rapid recovery pathway (RRP) without epidural catheter analgesia (ECA) or intravenous patient controlled analgesia (PCA) in accelerating recovery and decreasing opioid consumption in patients with adolescent idiopathic scoliosis (AIS) undergoing posterior spinal fusion (PSF). A retrospective cohort study included collection of demographics, ECA use, IV PCA, postoperative opioid consumption, postoperative pain scores, and reoperation rate. Opioid consumption was calculated using morphine milligram equivalents (MME). Hospital length of stay (HLOS) and first reported ambulation with physical therapy (PT) were also recorded. 53 patients were included, with 18 in the RRP group. Patient characteristics were comparable between the groups, except in ECA use and BMI. The RRP group consumed less total MME from postoperative day (POD) 0 to 2 (mean difference 61.6 MME; 95% CI 37.1-86.1 MME; p < 0.001). In addition, the RRP group had significantly shorter HLOS (2.5 vs 4.0days; p < 0.001). There were no differences in VAS scores between the two groups. A subset analysis comparing patients who did and did not receive ECA showed that ECA resulted in overall higher inpatient MME and HLOS. A prediction model was developed using multiple regression based on the different medications used for multimodal analgesia (MMA) in the RRP. An RRP without the use of ECA or IV PCA can provide adequate analgesia in patients with AIS undergoing PSF while lowering inpatient narcotic consumption and accelerating immediate postoperative recovery.

The effects of ultrasound-guided serratus anterior plane block on intraoperative opioid consumption and hemodynamic stability during breast surgery: A randomized controlled study.

Aim:To determine effect of ultrasound-guided serratus anterior plane block (SAPB) on intraoperative opioid consumption in patients undergoing oncoplastic breast surgery under general anesthesia.Methods:This study was conducted as a prospective, randomized controlled trial. Forty-four patients enrolled, aged 18 to 75 years with American Society of Anesthesiologists physical status I to III, undergoing elective oncoplastic breast surgery. Patients were randomly allocated to receive SAPB with 20 mL of 0.25% bupivacaine + general anesthesia (group SAPB) or only general anesthesia (group control). The primary outcome was assessing the effect of SAPB on intraoperative remifentanil consumption. Patients were assessed for emergence time, hemodynamic parameters, doses of rescue drugs used to control hemodynamic parameters, and duration of stay in the recovery room.Results:Preoperative SAPB with 0.25% bupivacaine reduced intraoperative opioid consumption (851.2 ± 423.5 vs 1409.7 ± 756.1 µg, P = .019). Emergence time was significantly shorter in group SAPB (6.19 ± 1.90 minutes) compared to group control (9.50 ± 2.39 minutes; P < .001). There were no significant differences in the doses of rescue drugs used for systolic blood pressure and heart rate between the groups.Conclusions:Preoperative SAPB with bupivacaine reduced intraoperative opioid consumption and shortened emergence time and duration of stay in the recovery unit, and hemodynamic stability was maintained without block-related complications.

Transversus Abdominis Plane Block Reduces Intraoperative Opioid Consumption in Patients Undergoing Periacetabular Osteotomy

Background: Administering intraoperative analgesia in patients undergoing periacetabular osteotomy (PAO) is challenging due to both the relevant surgical approach and osteotomies, which are associated with pain. The aim of this study was to assess the effect of the transversus abdominis plane block (TAPb) on intraoperative opioid consumption and circulation parameters in PAO patients. Patients and Methods: We conducted a two-group randomized-controlled trial involving 42 consecutive patients undergoing PAO for symptomatic developmental dysplasia of the hip (DDH) in our department. Patients assigned to the study group received an ultrasound-guided TAPb with 0.75% ropivacaine before the beginning of the surgery and after general anesthesia induction. Patients assigned to the control group did not receive a TAPb. General anesthesia was conducted according to a defined study protocol. The primary endpoint of the study was the intraoperative opioid consumption, measured in morphine equivalent dose (MED). Secondary endpoints were the assessment of intraoperative heart rate, mean arterial pressure (MAP), need for hypotension treatment, and length of hospital stay (LOHS). A total of 41 patients (n = 21 TAPb group, n = 20 control group) completed the study; of these, 33 were women (88.5%) and 8 were men (19.5%). The mean age at the time of surgery was 28 years (18–43, SD ± 7.4). All operations were performed by a single high-volume surgeon and all TAPb procedures were performed by a single experienced senior anesthesiologist. Results: We observed a significantly lower intraoperative opioid consumption in the TAPb group compared to the control group (930 vs. 1186 MED per kg bodyweight; p = 0.016). No significant differences were observed in the secondary outcome parameters. We observed no perioperative complications. Conclusion: Ultrasound-guided TAPb significantly reduces intraoperative opioid consumption in patients undergoing PAO.

Efficacy of PECS block in addition to multimodal analgesia for postoperative pain management in patients undergoing outpatient elective breast surgery: A retrospective study.

BackgroundPectoralis nerve blocks (PECS) have been shown in numerous studies to be a safe and effective method to treat postoperative pain and reduce postoperative opioid consumption after breast surgery. However, there are few publications evaluating the PECS block effectiveness in conjunction with multimodal analgesia (MMA) in outpatient breast surgery. This retrospective study aims to evaluate the efficacy of PECS's blocks on perioperative pain management and opioid consumption.MethodsWe conducted a retrospective study to assess the efficacy of preoperative PECS block in addition to preoperative MMA (oral acetaminophen and/or gabapentin) in reducing opioid consumption in adult female subjects undergoing outpatient elective breast surgery between 2015 and 2020. A total of 228 subjects were included in the study and divided in two groups: PECS block group (received PECS block + MMA) and control Group (received only MMA). The primary outcome was to compare postoperative opioid consumption between both groups. The secondary outcome was intergroup comparisons of the following: postoperative nausea and vomiting (PONV), incidence of rescue antiemetic medication, PACU non-opioid analgesic medication required, length of PACU stay and the incidence of 30-day postoperative complications between both groups.ResultsTwo hundred and twenty-eight subjects (n = 228) were included in the study. A total of 174 subjects were allocated in the control group and 54 subjects were allocated in the PECS block group. Breast reduction and mastectomy/lumpectomy surgeries were the most commonly performed procedures (48% and 28%, respectively). The total amount of perioperative (intraoperative and PACU) MME was 27 [19, 38] in the control group and 28.5 [22, 38] in the PECS groups (p = 0.21). PACU opioid consumption was 14.3 [7, 24.5] MME for the control group and 17 [8, 23] MME (p = 0.732) for the PECS group. Lastly, the mean overall incidence of postsurgical complications at 30 days was 3% (N = 5), being wound infection, the only complication observed in the PECS groups (N = 2), and hematoma (N = 2) and wound dehiscence (N = 1) in the control group.ConclusionPECS block combined with MMA may not reduce intraoperative and/or PACU opioid consumption in patients undergoing outpatient elective breast surgery.

To block or not to block? That is the question (114)

Objectives: Quadratus Lumborum (QL) blocks have gained popularity due to their more favorable safety profile compared to neuraxial techniques (e.g., epidural) in dealing with postoperative pain. They have been studied in the gynecologic population undergoing laparoscopic surgery, where pain scores were found to decrease as patients progressed through their recovery process. Yet, very little data exists studying their use in open surgery for gynecologic indications. Therefore, we aimed to determine the effect of QL blocks on postoperative opioid consumption in patients undergoing laparotomy. Methods: A retrospective study of gynecologic oncology patients undergoing surgery via laparotomy from 2018 to 2020 was performed. Demographics, postoperative pain scores, frequency, and duration of narcotic use, amount of narcotic use using Morphine Milligram Equivalents (MME), length of hospital stay, and re-admission rates for pain management were compared. Primary outcome measures include postoperative pain scores and the amount of narcotic use in MME. Results: Thirty-eight patients who met the inclusion criteria with complete data were identified as receiving QL blocks, whereas 32 patients did not receive a block during this time frame. Eighty-six percent of the blocks were placed preoperatively. Approximately 25% of patients reported their pain score on arrival to the floor as 0 out of 10. The mean pain score for patients with and without QL blocks on arrival to the floor were 2.9/10 and 3.7/10, respectively (p=0.57). Patients who received QL blocks used a mean of 18.4 MME on postoperative day 1 compared to 31.1 MME in those without blocks (p=0.008). This trend continued throughout their hospital course as the mean total MME used on hospital days 1-3 in the QL group was 49.11 compared to 80.24 in the non-QL group (p=0.009). Conclusions: Our study suggests that the use of regional QL blocks decreases the amount of narcotic pain medication (MME) used in the immediate postoperative period in patients undergoing laparotomy for gynecologic oncology indications. This is an important finding which may help decrease overall postoperative narcotic requirements given the current opioid epidemic. Future studies will focus on the impact of QL blocks on narcotic need after discharge in this patient population. Objectives: Quadratus Lumborum (QL) blocks have gained popularity due to their more favorable safety profile compared to neuraxial techniques (e.g., epidural) in dealing with postoperative pain. They have been studied in the gynecologic population undergoing laparoscopic surgery, where pain scores were found to decrease as patients progressed through their recovery process. Yet, very little data exists studying their use in open surgery for gynecologic indications. Therefore, we aimed to determine the effect of QL blocks on postoperative opioid consumption in patients undergoing laparotomy. Methods: A retrospective study of gynecologic oncology patients undergoing surgery via laparotomy from 2018 to 2020 was performed. Demographics, postoperative pain scores, frequency, and duration of narcotic use, amount of narcotic use using Morphine Milligram Equivalents (MME), length of hospital stay, and re-admission rates for pain management were compared. Primary outcome measures include postoperative pain scores and the amount of narcotic use in MME. Results: Thirty-eight patients who met the inclusion criteria with complete data were identified as receiving QL blocks, whereas 32 patients did not receive a block during this time frame. Eighty-six percent of the blocks were placed preoperatively. Approximately 25% of patients reported their pain score on arrival to the floor as 0 out of 10. The mean pain score for patients with and without QL blocks on arrival to the floor were 2.9/10 and 3.7/10, respectively (p=0.57). Patients who received QL blocks used a mean of 18.4 MME on postoperative day 1 compared to 31.1 MME in those without blocks (p=0.008). This trend continued throughout their hospital course as the mean total MME used on hospital days 1-3 in the QL group was 49.11 compared to 80.24 in the non-QL group (p=0.009). Conclusions: Our study suggests that the use of regional QL blocks decreases the amount of narcotic pain medication (MME) used in the immediate postoperative period in patients undergoing laparotomy for gynecologic oncology indications. This is an important finding which may help decrease overall postoperative narcotic requirements given the current opioid epidemic. Future studies will focus on the impact of QL blocks on narcotic need after discharge in this patient population.

Impact of Opioid-Free Anesthesia on Analgesia and Recovery Following Bariatric Surgery: a Meta-Analysis of Randomized Controlled Studies.

This meta-analysis aimed at exploring the impact of opioid-free anesthesia (OFA) on pain score and opioid consumption in patients undergoing bariatric surgery (BS). Literature search identified eight eligible trials. Forest plot revealed a significantly lower pain score (mean difference (MD) = - 0.96, p = 0.0002; 318 patients), but not morphine consumption (MD = - 5.85mg, p = 0.1; 318 patients) at postoperative 24h in patients with OFA than in those without. Pooled analysis also showed a lower pain score (p = 0.002), morphine consumption (p = 0.0003) in the postanesthetic care unit, and risk of postoperative nausea/vomiting (p = 0.0003) in the OFA group compared to the controls. In conclusion, this meta-analysis demonstrated that opioid-free anesthesia improved pain outcomes immediately and at 24h after surgery without a beneficial impact on opioid consumption at postoperative 24h. KEY POINTS: • Roles of opioid-free anesthesia (OFA) in bariatric surgery (BS) were investigated. • Outcomes included postoperative pain score, opioid use, and nausea/vomiting risk. • OFA was associated with lower 24-h pain score but not opioid consumption. • Lower pain score and opioid consumption were noted in the postanesthetic care unit. • OFA correlated with a lower risk of postoperative nausea/vomiting.

The quality of recovery after erector spinae plane block in patients undergoing breast surgery: a randomized controlled trial

BackgroundThe erector spinae plane (ESP) block has recently been shown to effectively alleviate postoperative pain and reduce opioid consumption in breast surgery patients. However, data are still limited concerning the quality of recovery in patients following this procedure.MethodsThis study was a randomized controlled trial (RCT) performed in a university hospital. We randomly allocated patients to one of three groups: ESP, SHAM, and control (CON). Procedures in the ESP and SHAM blocks were performed ipsilaterally with 0.375% ropivacaine or 0.9% saline (0.4 mL/kg). Our primary outcome was the assessment of the patient’s improvement with quality-of-recovery 40 (QoR-40) a day after surgery. Other outcome assessments included postoperative pain evaluation on the visual analog scale (VAS), 24-hour opioid consumption with patient-controlled analgesia (PCA), time to the first opioid demand, and global satisfaction with perioperative treatment.ResultsOverall, patients in the ESP group had improved QoR-40 compared to the CON group, 186 [177–193] vs. 175 [165–183] (medians and interquartile ranges). Pain severity was significantly higher in the CON group compared to the ESP group at hours 2 (38 [23–53] vs. 20 [7–32]) and 4 (30 [18–51] vs. 19 [7–25]). Moreover, we observed lower oxycodone consumption after 24 hours with the PCA pump between the ESP (4 [2–8] mg) and the CON (9.5 [5–19]) groups. Patients in the CON group used PCA sooner than those in the ESP group. Participants in the ESP group were more satisfied with treatment than those in the CON group. We found no statistical difference between SHAM and the other groups.ConclusionsCompared to the CON group, the ESP block improved the quality of recovery, alleviated pain intensity, and lowered opioid consumption in patients undergoing breast surgery. However, we did not observe this superiority in comparison with the SHAM group.Trial registrationNCT04726878.

High incidence of severe pain is associated with low opioid availability in patients with advanced cancer: a nationwide questionnaire survey in Japan

Opioid availability for the palliative care of patients with advanced cancer is increasing globally. However, opioid consumption in Japan is still extremely low compared with that in other countries. We investigated the current situation of pain control and opioid consumption in patients with advanced cancer in Japan. This was a national cohort study done in Japan after approval by the ethical committee of our institute the University of Tokyo Hospital (reference 202176NI). Between Sept 1, 2021, and Nov 15, 2021, caregivers from 2000 comprehensive support centres nationwide answered the web-based questionnaire survey asking for details about their assigned patients who died of end-stage cancer. The survey included the questionnaire of pain intensity and opioid prescription. Data from 1034 responders were retrieved, of which 1000 completed questionnaires for patients who died of end-stage cancer were considered valid. Of answers (excluding "I don't want to answer", "unknown", and "not applicable"), 254 (38%) of 665 patients complained of severe-to-intolerable cancer-related pain. Opioids were only available for 486 (77%) of 633 patients. The opioid adequacy rate, as defined by WHO, was negatively correlated with severe to intolerable pain (p=0·037). Only 344 (47%) of 730 patients with advanced cancer were supported by palliative care specialists. Pain control for advanced cancer pain is insufficient in Japan. In comparison with worldwide levels, opioid prescription is underused in clinical practice. The low availability of opioids can be improved by introduction of quality palliative care support for patients with advanced cancer. This study was funded by the authors and by Shionogi (Osaka, Japan), Nippon Zoki Pharmaceutical (Osaka, Japan), and Heartfelt (Kumamoto, Japan).

Ultrasound-guided superficial cervical plexus block reduces opioid consumption in patients undergoing craniotomy via suboccipital retrosigmoid approach: a randomized controlled trial

IntroductionThe effectiveness of superficial cervical plexus block (SCPB) at decreasing opioid use and improving hemodynamic stability during suboccipital retrosigmoid craniotomy has not been established. The aim of this study is...