4.5 Article

Implementation of a peri-operative pain-management algorithm reduces the use of opioid analgesia following pelvic exenteration surgery

期刊

COLORECTAL DISEASE
卷 25, 期 4, 页码 631-639

出版社

WILEY
DOI: 10.1111/codi.16442

关键词

cancer; pain; pelvic exenteration; pelvic resection

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This study investigated the implementation and outcomes of a pain-management regimen for patients undergoing pelvic exenteration surgery. The use of opioid-sparing regional techniques and preperitoneal catheters has increased since the implementation of a novel peri-operative pain-treatment algorithm. The dose of opioids required at the time of discharge has significantly reduced.
Aiml This study aimed to investigate the implementation and pain-related outcomes of a peri-operative pain-management regimen for patients undergoing pelvic exenteration surgery at a university teaching hospital. Method: This is a single-site prospective observational cohort study involving 100 patients who underwent pelvic exenteration surgery between January 2017 and December 2018. A pain-management algorithm regarding the use of opioid-sparing multimodal analgesia was developed between the departments of anaesthesia, pain management and intensive care. The primary outcomes were: compliance with a pain-treatment algorithm compared with a similar retrospective surgical patient cohort in 2013-2014; and requirements for regular doses of opioid analgesia at discharge, measured in oral morphine equivalent daily dose (oMEDD). Results: Following the introduction of a pain-management algorithm, regional anaesthesia techniques (spinal anaesthesia, transversus abdominus plane block, preperitoneal catheters or epidural analgesia) were used in 83/98 (84.7%) of the 2017-2018 cohort compared with 13/73 (17.8%) of the 2013-2014 cohort (p < 0.001). There was a reduction in the median dose of opioid analgesics (oMEDD) at time of discharge, from 150 mg (interquartile range [IQR]: 75.0-235.0 mg) in the 2013-2014 cohort to 10 mg (IQR: 0.00-45.0 mg) in the 2017-2018 cohort (p < 0.001). There was no change in pain intensity (assessed using the Verbal Numerical Rating Score) or oMEDD in the first 7 days following surgery. Conclusion: Since implementation of a novel peri-operative pain-treatment algorithm, the use of opioid-sparing regional techniques and preperitoneal catheters has increased. Additionally, the dose of opioids required at the time of discharge has reduced significantly.

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