Preserved Analgesia With Reduction in Opioids Through the Use of an Acute Pain Protocol in Enhanced Recovery After Surgery for Open Hepatectomy

Regional Anesthesia and Pain Medicine
Michael C GrantChristopher L Wu

Abstract

Enhanced recovery after surgery (ERAS) pathways are designed to restore baseline physiology, mitigate surgical stressors, and hasten recovery. Paramount to this approach is optimal pain control through multimodal analgesia and limiting reliance on opioid-based medications. Recent studies have fostered growing controversy surrounding the use of epidural analgesia in the ERAS setting, especially for higher-risk procedures. We examine the analgesic end points associated with the use of epidural within the ERAS framework for open hepatectomy. From November 2013 through March 2016, postoperative analgesic end points including daily morphine equivalent administration and self-reported pain scores were prospectively collected and analyzed for 180 consecutive patients scheduled for open hepatectomy. Patients whose surgeries performed prior to July 2014 were managed using traditional strategy (pre-ERAS, n = 60), and those after July 1 underwent a comprehensive perioperative ERAS pathway (ERAS, n = 120). Patients managed using the ERAS pathway had a significant reduction in morphine equivalent requirements at 24 hours (median, 10.0 vs 116.0 mg; P < 0.001), 48 hours (median, 10.1 vs 85.4 mg; P < 0.001), and 72 hours (median, 2.5 vs 60.0 m...Continue Reading

References

Feb 16, 2000·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·H ChenM S Didolkar
Jul 24, 2001·Anesthesiology·S Bar-YosefS Ben-Eliyahu
Dec 4, 2003·The British Journal of Surgery·A D G AndersonC J Mitchell
May 27, 2008·Journal of the American College of Surgeons·Andrew PageDavid A Kooby
Jan 13, 2009·Gastroenterology·Sven MullerUNKNOWN Zurich Fast Track Study Group
Jun 19, 2009·Clinical Nutrition : Official Journal of the European Society of Parenteral and Enteral Nutrition·Zuzana SerclováFrantisek Antos
Sep 9, 2009·Journal of Pain and Symptom Management·Helena KnotkovaRussell K Portenoy
Oct 21, 2009·Archives of Surgery·Kristoffer LassenUNKNOWN Enhanced Recovery After Surgery (ERAS) Group
Feb 24, 2012·Anesthesiology·Frances E LennonPatrick A Singleton
Aug 14, 2012·HPB : the Official Journal of the International Hepato Pancreato Biliary Association·Erica J RevieStephen J Wigmore
Oct 12, 2012·World Journal of Surgery·U O GustafssonUNKNOWN International Association for Surgical Metabolism and Nutrition (IASMEN)
Dec 5, 2014·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Andrew J PageTimothy M Pawlik
Jan 13, 2015·Annual Review of Public Health·Andrew KolodnyG Caleb Alexander

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Citations

Nov 16, 2017·Regional Anesthesia and Pain Medicine·Alexander B StoneMichael C Grant
Jul 3, 2018·Clinical Transplantation·Ahmed KhalilAbhinav Humar
Jul 12, 2018·Current Opinion in Anaesthesiology·Raphael Weiss, Daniel M Pöpping
Feb 15, 2019·Regional Anesthesia and Pain Medicine·Bradley H LeeChristopher L Wu
Jan 30, 2019·Annals of Plastic Surgery·Christopher Homsy, John T Lindsey
May 15, 2019·Anesthesia and Analgesia·Christopher L WuUNKNOWN Fourth Perioperative Quality Initiative Workgroup
Sep 25, 2017·Current Opinion in Anaesthesiology·Elke M E BosPhilipp Lirk
Jul 11, 2018·Perioperative Medicine·Elena J KoepkeMichael W Manning
Jan 29, 2019·Pain Medicine : the Official Journal of the American Academy of Pain Medicine·Kurt KroenkeMark Sullivan
Jun 19, 2019·Journal of Clinical Monitoring and Computing·MiHye ParkGaab Soo Kim
Dec 6, 2019·Peptides·Richard J Bodnar
Apr 14, 2021·European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society·Shahin MohseniCarol Jane Peden
Apr 26, 2021·Brazilian Journal of Anesthesiology·Thiago Mamoru SakaeJulio Cezar Mendes Brandão
Aug 15, 2021·Advances in Surgery·Hannah DeckerElizabeth Wick

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