Postoperative Opioid Use Research Articles

The Incidence and Risk Factors of Persistent Opioid Use After Surgery—a Retrospective Secondary Data Analysis.

The risk of persistent postoperative opioid use (PPOU) and its association with the type of surgery are still unclear in Germany. We conducted a nationwide retrospective cohort study on the basis of claims data from BARMER, a statutory health insurance carrier in Germany. Opioid-naive adults who did not have cancer and who underwent inpatient surgery in 2018 were included in the study. The operations were divided into 103 categories. PPOU was defined as the prescribing of opioids between postoperative days 1 and 90 and also between postoperative days 91 and 180 after hospital discharge. Patient-associated risk factors in the 12 months before surgery were investigated. 203 327 patients were included. 1.4% had PPOU (95% confidence interval [1.4; 1.5]). There were major differences between operation groups: major amputations and orthopedic procedures carried the greatest risk for the development of PPOU. The type of surgery had a larger effect on the risk of PPOU than pre-existing risk factors (explained variance 22.3% vs. 14.3%). Among such factors, alcohol abuse and pre-existing treatment with antidepressant drugs were associated with the highest risk for PPOU (odds ratios [OR] 1.515 [1.277; 1.797] and 2.131 [1.943; 2.336]). The incidence of PPOU in Germany is low (1.4%). The type of surgery plays an important role in its development.

Liposomal Bupivacaine Versus Plain Bupivacaine for Pain Control Following Congenital Cardiac Surgery.

Pain control following cardiac surgery can be challenging, and inadequate pain control is associated with postoperative complications. Liposomal bupivacaine can improve postoperative pain control due to its prolonged duration compared with plain bupivacaine. However, there is a paucity of data regarding its efficacy in congenital cardiac surgery. The primary outcome was to compare opioid requirements between liposomal bupivacaine and plain bupivacaine for local infiltration in pediatric patients undergoing cardiac surgical procedures via a median sternotomy approach. Secondary outcomes included antiemetic use, adjunct pain medication use, length of stay, and pain scores. This single center retrospective study analyzed data from 2017 to 2022 involving patients who underwent congenital cardiac surgery via median sternotomy. Sixty-three patients who received liposomal bupivacaine were matched with 33 patients who received plain bupivacaine. Patient data were extracted from the electronic medical record and underwent statistical analysis using Wilcoxon, χ2, and Fisher exact tests. There were no demographic differences between the two groups. Postoperative opioid use did not differ significantly between the liposomal bupivacaine and plain bupivacaine groups. The liposomal bupivacaine group had increased acetaminophen and antiemetic use, while the plain bupivacaine group had increased ketorolac use. Otherwise, there were no significant differences in secondary outcomes, including length of stay. Liposomal bupivacaine may not offer any advantage over plain bupivacaine in congenital cardiac postoperative pain control.

Intraoperative Methadone in Spine Surgery ERAS Protocols: A Systematic Review of the Literature.

Systematic review. To systematically review the use of intraoperative methadone in spine surgery and examine its effects on postoperative opioid use, pain, length of stay, and operative time. Spine surgery patients commonly have a history of chronic pain and opioid use, and as a result, they are at an increased risk of severe postoperative pain. While pure mu opioids remain the standard for acute surgical pain management, they are associated with significant short-term and long-term adverse events. Methadone presents an alternative to pure mu opioids which may improve postoperative management of pain following intraoperative use. A systematic review of MEDLINE, Embase, and Web of Science databases was conducted to review existing literature detailing operating time, postoperative pain, opioid usage, and hospital length of stay (LOS) following intraoperative methadone administration in spine surgery. Following screening of 994 articles and application of inclusion criteria, 8 articles were included, 4 of which were retrospective. Conventional spine surgery intraoperative analgesic strategies used as comparators for intraoperative methadone included hydromorphone, ketamine, and sufentanil. Considering patient outcomes, included studies observed that patients treated with intraoperative methadone had statistically similar or significantly reduced pain scores, opioid usage, and LOS compared with comparator analgesics. However, one study observed that intraoperative methadone used in a multimodal analgesia regimen strategy with ketamine resulted in a shortened LOS compared with the use of intraoperative methadone alone. Differences in operating time between cases that used intraoperative methadone and cases that used comparator analgesics were not statistically significant among included studies. Methadone may present an alternative option for both intraoperative and postoperative analgesia in spine surgery recovery protocols and may reduce postoperative pain, opioid use, and LOS while maintaining consistent operating time and reduced side effects of pure mu opioids. Level II.

Preoperative Acetaminophen For Microsuspension Laryngoscopy Reduces Postoperative Opioid Use.

The opioid crisis has prompted consideration of analgesic prescriptions. This study explored the value of preoperative acetaminophen for pain control following microsuspension laryngoscopy (MSL) and compared the results with a previous study of pain and opioid use following MSL (Tsang et al.). A prospective open-label clinical trial was conducted in patients undergoing MSL. All patients were administered preoperative acetaminophen. Short-form McGill Pain Questionnaire (SF-MPQ), pain visual analogue scale (VAS), and present pain intensity (PPI) scores were collected preoperatively and on postoperative days (PODs) 1, 3, 7, and 14. Statistical analysis identified variables associated with opioid use or increased pain scores, and compared outcomes with Tsang et al. RESULTS: Eighty-nine patients were included (mean age 52.8 ± 17.3 years, 40 males). All patients received preoperative 1 g acetaminophen (77 (86.5%) orally) with no adverse effects. On POD1, opioid usage was 10%. Median [IQR] pain scores were 5 [2-11], 21 [12.3-56.8], and 3 [2-3.3] on SF-MPQ, VAS, and PPI, respectively. Post-Anesthesia Care Unit (PACU) opioid requirements significantly correlated with POD1 opioid consumption (τb = 0.214; p ≤ 0.05), and significant associations with PACU opioid administration were found for total anesthesia time (OR (95%CI) = 1.271 (1.043-1.548), p = 0.017) and total laryngoscope suspension time (OR (95%CI) = 0.791 (0.651-0.962, p = 0.019)). This cohort demonstrated reduced opioid usage on POD1 compared with Tsang et al (23%). Preoperative acetaminophen is a safe intervention, resulting in decreased postoperative opioid use following MSL. Anesthesia time correlated with need for postoperative opioids. 4 Laryngoscope, 134:4625-4635, 2024.

Enhanced Recovery Protocol Decreases Postoperative Opioid Use after Penile Inversion Vaginoplasty.

Penile inversion vaginoplasty (PIV) entails considerable soft-tissue dissection to the perineal region and involves complex tissue rearrangement. This study examines the role of an enhanced recovery after surgery (ERAS) pathway after PIV in reducing opioid use and controlling postoperative pain. A retrospective study of 50 transfemale patients who underwent PIV at a single institution from June 2021 to January 2023 was completed. The study compared 2 groups of patients who were given different postoperative pain management regimens: group A received standard postoperative analgesics and group B received ERAS. Variables such as postoperative pain scores on the numeric pain rating scale (0-10), use of opioid medication, length of hospital stay, and patient comorbidities were recorded and compared across the 2 groups. The average hospital stay length was 4.92 (±0.85) days. Group A had a slightly longer average stay compared with group B. The average pain level in both groups was 4.25 (SD ±1.51). Group A exhibited a slightly higher average pain level of 4.31 (±1.53), whereas group B exhibited 4.16 (SD±1.51) (P = 0.77). Although pain levels did not significantly vary between the 2 groups, there was a statistically significant decrease in the amount of opioid medication used in group B with a P value of 0.009. ERAS protocol is effective in decreasing opioid usage in the immediate postoperative setting after PIV.

11948 Spinal Anesthesia Prior to Laparoscopic Hysterectomy Resulted in Decreased Postoperative Pain and Opioid Use

11948 Spinal Anesthesia Prior to Laparoscopic Hysterectomy Resulted in Decreased Postoperative Pain and Opioid Use

Effect of erector spinae plane block and thoracic epidural anesthesia on hospital length of stay and postoperative opioid use after mastectomy

BackgroundAdequate postoperative pain control is essential after mastectomy. This study compares the influence of 2 regional analgesia techniques on length of stay and opioid use to systemic analgesia alone. MethodsPatients treated with mastectomy from 2014 to 2020 were stratified according to perioperative analgesic modality (systemic analgesia versus thoracic epidural anesthesia or erector spinae plane block). Demographic, tumor, and treatment characteristics were compared. Outcome variables included postoperative anesthesia unit and hospital length of stay, postoperative day 1 and 2 discharge rates, and inpatient opioid use (in oral milligram morphine equivalents). ResultsOf 316 patients, 171 received systemic analgesia, 72 thoracic epidural anesthesia, and 73 erector spinae plane block. On univariate analysis, there were significant differences in age, neoadjuvant chemotherapy, bilateral surgery, immediate reconstruction, and Her2 positivity rates. Thoracic epidural anesthesia had the longest hospital length of stay, and erector spinae plane block the shortest, compared with systemic analgesia (52.1 vs 28 vs 30.6 hours, P < .0001). Postoperative day 1 discharge was more likely with erector spinae plane block than systemic analgesia and less likely with thoracic epidural anesthesia (89% vs 68.4% vs 30.6%, P < .0001). Erector spinae plane block required significantly less milligram morphine equivalents than thoracic epidural anesthesia or systemic analgesia on postoperative day 1 (10 vs 18.75 vs 20 milligram morphine equivalents, P < .0009), but no differences on postoperative day 2 (23.5 vs 20 vs 25 milligram morphine equivalents, P = .84). Total hospital opioid use was significantly lower for erector spinae plane block than thoracic epidural anesthesia or systemic analgesia (24 vs 32.3 vs 32 milligram morphine equivalents, P = .024). On multivariate analysis, thoracic epidural anesthesia was associated with significantly longer length of stay, whereas neither thoracic epidural anesthesia nor erector spinae plane block was associated with decreased opioid use. ConclusionRegional analgesia is not significantly associated with decreased opioid use or hospital length of stay.

Assessment of Clinical Outcomes and Pain Management of Single-Level Lumbar Laminectomy Between Unilateral Biportal Endoscopic, Tubular, and Open Approaches

Objective: While minimally invasive surgical procedures have been shown to reduce postoperative pain and recovery time compared to an open surgical approach, few studies have also compared pain management, particularly involving the use of unilateral biportal endoscopy (UBE). Methods: Patients who underwent single-level laminectomy through a UBE, open, or tubular technique were chart-reviewed for up to 90 days for perioperative outcomes, including opioid and nonopioid utilization. The chi-square test and analysis of variance were used to analyze differences in characteristics and outcomes between groups. The post hoc Tukey test and multinomial regression were conducted when significance was found in initial tests.Results: In total, 184 patients were included in the study (110 open, 44 tubular, 30 UBE). The UBE patients were the oldest. Post hoc analysis showed that UBE and tubular patients had significantly lower blood loss than the open group (p&lt;0.05). Moreover, UBE surgery was associated with significantly longer operative times than both tubular and open surgery (p&lt;0.05). No significant differences were observed in complications, 90-day readmissions, or return to the operating room. Postdischarge, patients in the open and tubular groups had higher rates of acetaminophen and cyclobenzaprine prescriptions, respectively, than the UBE group (p&lt;0.05). Postoperative opioid use at 2 weeks significantly differed among groups. When controlling for age and preoperative opioid use, multivariate regression revealed that patients who underwent decompression by UBE had lower odds of postdischarge opioid use at 2 weeks than the open group (53.20% vs. 21.70%; odds ratio [OR], 0.267; 95% confidence interval [CI], 0.09–0.79; p=0.017) and the tubular group (50.0% vs. 21.70%; OR, 0.268; 95% CI, 0.08–0.91; p=0.038). No statistically significant between-group differences were observed for ongoing opioid use at the 6-week and 3-month time points.Conclusions: Patients who underwent UBE had significantly lower odds of postdischarge narcotic use at 2-week follow-up than those undergoing the open and tubular approaches.

Clinical audit on management of Post Operative Nausea and Vomiting

Postoperative nausea and vomiting (PONV) are common complications following surgery, affecting up to 30% of patients despite advances in anaesthesia and surgical techniques. It can be distressing for patients and may lead to complications such as dehydration, electrolyte imbalances, wound dehiscence, and delayed recovery. Several factors contribute to PONV, including patient-related factors (such as age, gender, history of motion sickness, and smoking), anaesthesia-related factors (type and duration of anaesthesia, use of volatile anaesthetics, opioids, and muscle relaxants), and surgical factors (type and duration of surgery, intraoperative hypotension, and use of certain drugs like opioids and nitrous oxide). It can be determined by APFEL score which says that female sex, non-smokers, history of motion sickness and post operative use of opioids have high chances of PONV. Although PONV is a very detrimental disorder, it can last for several hours to days. Not only it depends on the anaesthetic factors it is also affected by surgical stress. PONV is said to the most important factor resulting to delayed recovery and prolonged hospital stay.

The use of tourniquet in total knee arthroplasty does not impact the functional outcome: a randomised controlled study

BackgroundThis study evaluates the clinical evidence for performing total knee arthroplasty (TKA) without a tourniquet, a shift from the near-universal use in 2009 to current trends towards tourniquet-less TKA in Norway and Sweden. This change is set against a backdrop of conflicting evidence regarding the positive and negative effects of tourniquet use.Questions/purposesThe aims were to determine if the tourniquet has an impact on [1] Forgotten Joint Score-12 (FJS-12) at 8 weeks after surgery; [2] postoperative strength and function; [3] postoperative pain and opioid analgesic use; and [4] operative time, bleeding, and length of stay (LOS).MethodsEighty-one patients were randomised to TKA with or without a tourniquet. The outcome measures, FJS-12, muscle strength, functional test, pain, estimated blood loss, haemoglobin (Hb) loss, knee circumference, opioid consumption, and LOS were assessed preoperatively and at 1 day, 8 weeks, and 1 year after surgery.ResultsNo significant difference in FJS-12 scores was found between the two groups at postoperative 8 weeks. However, the tourniquet group showed statistically significant better knee extension strength at 8 weeks (p = 0.045). There were no differences in other outcomes, except for a greater decrease in haemoglobin levels (p = 0.02) and higher estimated perioperative blood loss (p < 0.001) in the no tourniquet group than the torniquet group.ConclusionsOur study indicates that tourniquet use during TKA causes no significant differences in FJS-12 at 8 weeks, significantly reduces bleeding and postoperative Hb loss, and improves quadriceps strength at 8 weeks.Trial registrationClinicaltrails.gov. Registry Number: NCT03666598. Registered 30 August 2018.

Patient-reported outcomes, postoperative pain and pain relief after day case surgery (POPPY): methodology for a prospective, multicentre observational study.

In the UK, approximately 70% of surgical procedures are undertaken as day-cases. Little information exists about recovery from day-case surgery, yet international data highlights patients are at risk of developing significant longer-term health problems including chronic post-surgical pain and persistent postoperative opioid use. The Patient-reported Outcomes, Postoperative Pain and pain relief after daY case surgery (POPPY) study was a national prospective multicentre observational study, measuring short- and longer-term patient-reported outcomes, postoperative pain and pain relief after day-case surgery. This was a collaborative project led by resident anaesthetists under the Research and Audit Federation of Trainees umbrella. Adult day-case surgical patients were recruited on the day of surgery. Baseline data including patient characteristics; procedure details; pre-operative analgesic use; pre-existing pain; and quality of life scores were recorded. Patients were followed up through automated short message service messages. Short-term (postoperative days 1, 3 and 7) outcomes included: quality of recovery; pain severity; impact of pain on function; and analgesic use. Longer-term outcomes (postoperative day 97) included: quality of life; analgesic use; incidence of chronic post-surgical pain; and incidence persistent postoperative opioid use. Additional outcomes were completed by those patients with chronic post-surgical pain and persistent postoperative opioid use, with 30 patients recruited to a qualitative semi-structured interview study exploring postoperative expectations, recovery, postoperative pain and opioid use. An embedded pilot study at four sites recruited 129 patients. Responses to the automated short message service were gained from 129 patients (100%) at day 1; 116 (89.9%) at day 3; 108 (83.7%) at day 7; and 77 (59.7%) at day 97 postoperatively. The pilot enabled refinement of the methods and processes before the national roll out. This paper outlines the methods for the POPPY study, the largest UK multicentre prospective observational study considering short- and longer-term outcomes following day-case surgery.

Postoperative opioid use in Norway—a population-based observational study on patterns of long-term use

BackgroundThe utilization patterns of opioid analgesics and the proportion of long-term opioid use after surgery in Norway is largely unknown.MethodsThis study aimed to estimate the proportion of one-year long-term prescription opioid use among all Norwegian postoperative opioid users. Complete data from central health registries (NPR, NorPD, Statistics Norway, CoDR) were linked via the personal identification number unique to all citizens. The study period was January 1st 2010 until December 31st 2019. Long-term opioid use was defined as at least two opioid dispensings within two subsequent 90-day periods, with a minimum average use of 10 MME/day for the first 90 days.ResultsThe study population consisted of 693 495 post-operative opioid users (53.6% women), whereof 73.2% had not used opioids the year before surgery (new users). Among the postoperative opioid users, 3.8% were one-year long-term opioid users. The corresponding figures for new and previous opioid users were 0.4% and 13.1%, respectively. The highest proportions of long-term opioid use were found after transluminal endoscopy, eye surgery and assessments related to surgical procedures. In previous opioid users, the proportion of one-year long-term use was higher among women than men in all age groups, a difference that increased with age.ConclusionsThe proportion of postoperative long-term opioid use in Norway is generally low. We detected higher proportions of long-term opioid use after certain types of surgery, but our crude surgery definition warrants further examination. Previous opioid users pose a particular challenge in the management of postoperative pain.Trial registrationThe study used national health registry data from the period 2010–2019. A pre-registered analysis plan is available at Open Science Framework.

Prevalence and Impact of Constipation on Reconstructive Outcomes Following Endoscopic Skull Base Surgery

Abstract Objective Postoperative constipation in endoscopic skull base surgery (ESBS) may provoke undesired straining, which, in theory, may create intracranial pressure shifts and impact skull base reconstruction. The purpose of this study is to assess the prevalence and contributing factors to postoperative constipation after ESBS, and whether this impacts reconstructive outcomes. Methods Patients undergoing ESBS between July 2018 and December 2022 at a single-center, tertiary academic skull base surgery program were retrospectively reviewed. Chart reviews were performed to identify average bowel movements per day, indication for surgery, age, sex, body mass index (BMI), history of chronic pain, length of postoperative bedrest, length of stay (LOS), and postoperative use of opioid analgesics. Additionally, use of a standing stool bowel regimen, as-needed (PRN) stool softeners/laxatives, and enemas were recorded. Constipation was defined as greater than 48 hours without a bowel movement. Results In total, 213 patients (115 with intradural pathologies) were identified, of which 146 (69%) patients had postoperative constipation. Postoperative constipation was associated with longer bedrest (1.86 ± 0.20 vs. 1.06 ± 0.12 days; p = 0.011); increased morphine equivalent dose (MED) during postoperative days 2, 3, 5, and 6 (all p &lt; 0.05); and total postoperative MED (106.70 ± 14.01 vs. 46.88 ± 8.44 mg; p &lt; 0.001). Additionally, postoperative constipation was an independent predictor of LOS (p = 0.009). There were no differences in postoperative cerebrospinal fluid (CSF) leak between the groups (p = 0.622). Conclusion Postoperative constipation rates were high after ESBS and likely causative factors include increased immobilization and postoperative opioid use. Standing bowel regimens should be considered in ESBS patients. However, there was no increased rate of postoperative CSF leaks.

Safety and Efficacy of Ketorolac After Craniotomy for Tumor Resection

ObjectivePostoperative pain is the most common undesirable outcome after neurosurgery. Ketorolac is a non-steroidal anti-inflammatory drug (NSAID) which is administered parenterally and carries a theoretical increased risk of bleeding. Our study aims to determine whether ketorolac after craniotomy for tumor resection significantly changes the rate of postoperative adverse events, adequately controls pain, and decreases concurrent narcotic usage. MethodsWe performed a retrospective chart review of all adult patients who underwent craniotomy for brain tumor resection from 2013 to 2022. Analysis of patients who received ketorolac and those who did not in the post-operative period were compared for adverse events associated with ketorolac use. Secondary outcomes included patient-reported pain scores and postoperative opioid usage. Results1,114 patients were included, of which 70 received ketorolac in the postoperative period. Patients who received ketorolac often received it after narcotics failed to provide adequate pain control. Patients receiving ketorolac were younger (p=0.001) and had a lower comorbidity index (p=0.041) compared to the non-ketorolac group. Patients receiving ketorolac did not experience a significantly increased rate of bleeding events (p=0.850). Patients recieving ketorolac had significantly higher baseline levels of pain (p=0.018) and opioid usage (p=0.047). When matched for chronic comorbidities including pain disorders, the ketorolac group only displayed higher levels of pain early in the postoperative course (POD 0-1) but not in latter part of the initial postoperative period. ConclusionsKetorolac is a safe and effective option for pain control after craniotomy for tumor resection. Prospective data is needed to better validate these retrospective observations.

The Impact of Pudendal Nerve Injection in Vaginal Surgery: A Secondary Analysis

Importance Evidence regarding the effect of pudendal nerve blockade during vaginal surgery is conflicting. Previous studies compared pudendal nerve blockade to either normal saline placebo injection or no injection, demonstrating small or no difference in pain outcomes. Studies investigating nerve blocks at the time of vaginal surgery have not evaluated the effect of infiltration of the space around the pudendal nerve. Objective The aim of the study was to determine whether intraoperative pudendal nerve injection (bupivacaine or normal saline) will result in improved pain scores and satisfaction compared with patients who receive no pudendal injection. Study Design We performed a secondary analysis of 2 randomized controlled trials investigating postoperative pain after vaginal reconstructive surgery, comparing the outcomes of the following 3 groups: control (no pudendal injection), intervention (bilateral pudendal nerve blockade), and placebo (bilateral normal saline pudendal injections). The primary outcome was postoperative pain scores. Secondary outcomes were opioid use, patient satisfaction, and postoperative complications. Linear mixed effects models were applied to outcomes, and treatment effects with 95% confidence intervals were estimated at each time point from the model. Results One hundred four patients who underwent vaginal surgery were included: 36 pudendal nerve block, 35 normal saline pudendal injection, and 33 no injection. The groups were well-matched. Linear mixed effects models demonstrated no significant differences between treatment groups for postoperative pain severity scores, opioid use, and patient-reported satisfaction at each time point. Conclusions Normal saline injection and no injection seem to have no clinically meaningful difference in effect, and either could reasonably serve as control for pudendal blockade during vaginal surgery.

Use of liposomal bupivacaine in cats undergoing gastrointestinal surgery is associated with lower doses of full µ-opioid agonists postoperatively

Objectives The aim of the study was to analyze the association of the administration of liposomal bupivacaine (Nocita) with postoperative opioid use in cats undergoing gastrointestinal surgery, as well as to analyze the administration of antiemetics postoperatively in this study population to qualify the degree of nausea related to opioid administration. Methods Records of 187 cats undergoing gastrointestinal surgery across two institutions, the Matthew J Ryan Veterinary Hospital at the University of Pennsylvania and the University of Florida Small Animal Hospital, were analyzed for multilayer liposomal bupivacaine infiltration at the time of abdominal closure, postoperative injectable opioid use and postoperative injectable antiemetic use. Results Cats that were administered liposomal bupivacaine at the time of abdominal closure received significantly lower doses of full µ-opioid agonists postoperatively. Significantly more cats that received liposomal bupivacaine were managed with full µ + partial µ-opioid agonists postoperatively than any other opioid profile. Cats that received liposomal bupivacaine received lower doses of ondansetron in hospital compared with cats that did not receive liposomal bupivacaine. Conclusions and relevance This study suggests that in cats requiring analgesia postoperatively, the use of liposomal bupivacaine at closure reduces the use of full µ-opioid agonists postoperatively. In addition, more patients that received liposomal bupivacaine were de-escalated from full µ-opioid agonists to partial µ-opioid agonists during their hospital stay, suggesting that less analgesia was required throughout their hospitalization. Lastly, lower doses of ondansetron, a typical second-line antinausea medication after gastrointestinal surgery, were used in cats that received liposomal bupivacaine, which may suggest less postoperative nausea.

Intercostal Nerve Cryoablation in Lung Transplantation: A Single-Center, Propensity-Matched Analysis

ObjectiveAchieving adequate pain control after lung transplantation is an essential milestone in a patient’s recovery. We compared postoperative opioid use, clinical outcomes, and respiratory function in lung transplant recipients treated with intercostal nerve cryoablation (INC) vs standard pain management. MethodsWe reviewed all adult lung transplants performed at our center between January 2016 and December 2022. We excluded cases performed through median sternotomy , patients with prior thoracotomies, multiorgan transplants, and redo transplants. We performed a propensity matched analysis, comparing patients who received INC versus standard pain management The primary outcome was cumulative postoperative opioid use in morphine milligram equivalents (MME) by POD 14. Secondary outcomes included opioid use on POD5 and POD10, perioperative outcomes, 1-year survival and longitudinal measurement of respiratory function. ResultsPropensity matching resulted in 85 patients in each group. Compared to standard pain management, the INC group had a lower cumulative opioid use by POD 14 (509 vs 864 MME, p=0.032). In addition, the INC group had a lower opioid use at POD5, POD10, POD14, no difference in perioperative outcomes, and similar 1-year survival. The INC group had better respiratory function at 6 and 12-months posttransplant compared to the standard pain management group. ConclusionsIn our single center analysis, INC was associated with lower opioid use and improved respiratory function after lung transplant. This report adds to the growing literature supporting the use of INC in multimodal pain management strategies and enhanced recovery protocols in lung transplant.

Continuous Incisional Infusion of Local Anaesthetic (CIILA) reduces postoperative opioid usage in children.

Continuous Incisional Infusion of Local Anaesthetic (CIILA) reduces postoperative opioid usage in children.

Is there really no association between postoperative opioid use and long-term surgical outcomes in patients diagnosed with liver cancer?: Erratum

Is there really no association between postoperative opioid use and long-term surgical outcomes in patients diagnosed with liver cancer?: Erratum

Comparison Between Ketamine and Dexmedetomidine in Achieving Opioid Sparing Sedoanalgesia in Patients Following Open Heart Surgery: A Randomized Clinical Trial

Background: Opioid-sparing sedoanalgesia relies on non-opioid multimodal analgesic and sedative agents. It is being developed to decrease or eliminate opioid use for the management of acute postoperative pain to avoid opioid complications. This study aimed to compare ketamine and dexmedetomidine for their efficiency and safety in inducing opioid-sparing sedoanalgesia in patients following open heart surgery. Methods: Ninety adult cardiac patients who underwent open heart surgery were enrolled. They were randomly divided into three groups. Group D received a dexmedetomidine infusion of 0.1– 0.2 μg/kg/hour, group K received a ketamine infusion of 1–2 μg/kg/min while group C received a placebo as a control group. Drugs were given after the operation in the surgical intensive care unit. Total postoperative opioid consumption was the primary outcome. Richmond agitation sedation scale, visual analog pain scale, time to first analgesic request, patient satisfaction, and incidence of any complications were recorded. Results: In this study, we found that the median (interquartile range) postoperative opioid consumption was significantly lower in groups D and K than in group C (156 (40), 140 (83), 185 (110); p &lt; 0.001). Richmond agitation sedation scale was statistically significant until 6 hours postoperative (p-value: &lt; 0.05). Patient satisfaction score was higher in groups D and K than in group C (p-value: 0.005). On the other side, there is no statistically significant difference between the three study groups regarding time to first analgesic request (minutes) (p-value: 0.064) or visual analog pain scale (p-value: &gt; 0.05). Incidence of complications was highly significant between the study groups (p-value: &lt; 0.001). Conclusions: To decrease postoperative opioid use with their multiple side effects and improve patient satisfaction scores in patients undergoing open heart surgery under general anesthesia, the use of either ketamine or dexmedetomidine is recommended in the postoperative period as an adjuvant modality and a good idea with observation of possibility of some preventable side effects.