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Comparative Study
. 2018 Oct;127(4):1044-1050.
doi: 10.1213/ANE.0000000000003342.

A Dedicated Acute Pain Service Is Associated With Reduced Postoperative Opioid Requirements in Patients Undergoing Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy

Engy T Said  1 , Jacklynn F Sztain  1 , Wendy B Abramson  1 , Minhthy N Meineke  1 , Timothy J Furnish  1 , Ulrich H Schmidt  1 , Gerard R Manecke  1 , Rodney A Gabriel  1   2
Affiliations
Comparative Study

A Dedicated Acute Pain Service Is Associated With Reduced Postoperative Opioid Requirements in Patients Undergoing Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy

Engy T Said et al. Anesth Analg. 2018 Oct.

Abstract

Background: The Acute Pain Service (APS) was initially introduced to optimize multimodal postoperative pain control. The aim of this study was to evaluate the association between the implementation of an APS and postoperative pain management and outcomes for patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC).

Methods: In this propensity-matched retrospective cohort study, we performed a before-after study without a concurrent control group. Outcomes were compared among patients undergoing CRS-HIPEC when APS was implemented versus historical controls (non-APS). The primary objective was to determine if there was a decrease in median total opioid consumption during postoperative days 0-3 among patients managed by the APS. Secondary outcomes included opioid consumption on each postoperative day (0-6), time to ambulation, time to solid intake, and hospital length of stay.

Results: After exclusion, there were a total of 122 patients, of which 51 and 71 were in the APS and non-APS cohort, respectively. Between propensity-matched groups, the median (quartiles) total opioid consumption during postoperative days 0-3 was 27.5 mg intravenous morphine equivalents (MEQs) (7.6-106.3 mg MEQs) versus 144.0 mg MEQs (68.9-238.3 mg MEQs), respectively. The median difference was 80.8 mg MEQs (95% confidence interval, 46.1-124.0; P < .0001). There were statistically significant decreases in time to ambulation and time to solid diet intake in the APS cohort.

Conclusions: After implementing the APS, CRS-HIPEC patients had decreased opioid consumption by >50%, as well as shorter time to ambulation and time to solid intake. Implementation of an APS may improve outcomes in CRS-HIPEC patients.

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Conflict of interest statement

Conflicts of Interest: See Disclosures at the end of the article.

Figures

Figure 1.
Figure 1.
Diagram illustrating the multimodal approach by the Acute Pain Service for postoperative opioid-sparing analgesia for patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.
Figure 2.
Figure 2.
Exclusion and inclusion methodology. APS indicates Acute Pain Service; BMI, body mass index; HIPEC, hyperthermic intraperitoneal chemotherapy.
Figure 3.
Figure 3.
Trends in total opioid consumption during PODs 0–3 during the historical control and Acute Pain Service time periods. Each dot represents a patient ordered chronologically based on day since start of study period. IV indicates intravenous; POD, postoperative day.
Figure 4.
Figure 4.
Difference in median total opioid use (mg) on each POD in patients managed by the APS versus historical controls (propensity matched). Blue arrow represents mean day at which epidural was removed/dislodged in historical controls. Red arrow represents mean day at which epidural was removed/dislodged in the APS group. *P < .007 (adjusted for multiple comparisons). APS indicates Acute Pain Service; IV, intravenous; POD, postoperative day.
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