One shot to control Pain: Decreasing postoperative opioid use in gynecologic oncology patients with intrathecal opioid injection
Objectives: To determine whether regional anesthesia with single-shot intrathecal opioid injections (ITO) reduce postoperative pain and intravenous (IV) opioid use after exploratory laparotomy in major gynecologic surgeries. Methods: A retrospective chart review of 315 consecutive cases of patients...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-11-01
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| Series: | Gynecologic Oncology Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352578921001624 |
| _version_ | 1818398787974987776 |
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| author | Yevgeniya Ioffe Ruofan Yao Eileen Hou Michelle Wheeler Mohamed Nour Wei Yun Wang Linda Hong |
| author_facet | Yevgeniya Ioffe Ruofan Yao Eileen Hou Michelle Wheeler Mohamed Nour Wei Yun Wang Linda Hong |
| author_sort | Yevgeniya Ioffe |
| collection | DOAJ |
| description | Objectives: To determine whether regional anesthesia with single-shot intrathecal opioid injections (ITO) reduce postoperative pain and intravenous (IV) opioid use after exploratory laparotomy in major gynecologic surgeries. Methods: A retrospective chart review of 315 consecutive cases of patients who underwent an exploratory laparotomy on the gynecologic oncology service from July 2015 to January 2018 was conducted. Single-shot ITO was offered to all patients undergoing open abdominal surgery. The primary outcomes of interest were IV opioid use in morphine equivalents during the first 48 hours after surgery. Univariate analyses were performed to estimate the effect of ITO on IV opioid use at 0, 6, 12, 24 and 48 hours after surgery. Longitudinal regression analyses were performed to estimate the effect of ITO on changes in outcomes of interest over time, adjusting for potential confounders. Results: 35% (110/315) received ITO preoperatively. There were no differences in patient age, BMI, previous number of abdominal surgeries, history of opioid dependence, type of gynecologic surgery, or total EBL between the ITO and control groups. Preoperative ITO was associated with a significantly lower IV opioid requirement between 0 and 6 hours after surgery (9.7 ± 8.1 vs 14.3 ± 11.5, p < 0.0001) and between 6 and 12 hours after surgery (2.7 ± 3.8 vs 5.4 ± 9.5, p = 0.0054). There was no statistically significant difference in total hospital stay opioid requirement but median length of stay was increased by 1 day. Conclusions: Preoperative administration of ITO reduced IV opioid requirement in the first 12 hours postoperatively but was associated with median 1 day increase in hospital stay. |
| first_indexed | 2024-12-14T07:10:21Z |
| format | Article |
| id | doaj.art-5abf07c7b89c44ebbb27430a53a05238 |
| institution | Directory Open Access Journal |
| issn | 2352-5789 |
| language | English |
| last_indexed | 2024-12-14T07:10:21Z |
| publishDate | 2021-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Gynecologic Oncology Reports |
| spelling | doaj.art-5abf07c7b89c44ebbb27430a53a052382022-12-21T23:11:53ZengElsevierGynecologic Oncology Reports2352-57892021-11-0138100858One shot to control Pain: Decreasing postoperative opioid use in gynecologic oncology patients with intrathecal opioid injectionYevgeniya Ioffe0Ruofan Yao1Eileen Hou2Michelle Wheeler3Mohamed Nour4Wei Yun Wang5Linda Hong6Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA, 92354Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA, 92354Advocate Outpatient Center, 9555 S. 52nd Ave, 2nd floor, Oak Lawn, IL, 60453Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA, 92354Kaiser Permanente West Los Angeles Medical Center, 6041 Cadillac Avenue, Los Angeles, CA 90034University of Washington, 1959 NE Pacific Street, BB-1469, Seattle, WA, 98195Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA, 92354; Corresponding author at: 11234 Anderson St, Loma Linda, CA, 92354.Objectives: To determine whether regional anesthesia with single-shot intrathecal opioid injections (ITO) reduce postoperative pain and intravenous (IV) opioid use after exploratory laparotomy in major gynecologic surgeries. Methods: A retrospective chart review of 315 consecutive cases of patients who underwent an exploratory laparotomy on the gynecologic oncology service from July 2015 to January 2018 was conducted. Single-shot ITO was offered to all patients undergoing open abdominal surgery. The primary outcomes of interest were IV opioid use in morphine equivalents during the first 48 hours after surgery. Univariate analyses were performed to estimate the effect of ITO on IV opioid use at 0, 6, 12, 24 and 48 hours after surgery. Longitudinal regression analyses were performed to estimate the effect of ITO on changes in outcomes of interest over time, adjusting for potential confounders. Results: 35% (110/315) received ITO preoperatively. There were no differences in patient age, BMI, previous number of abdominal surgeries, history of opioid dependence, type of gynecologic surgery, or total EBL between the ITO and control groups. Preoperative ITO was associated with a significantly lower IV opioid requirement between 0 and 6 hours after surgery (9.7 ± 8.1 vs 14.3 ± 11.5, p < 0.0001) and between 6 and 12 hours after surgery (2.7 ± 3.8 vs 5.4 ± 9.5, p = 0.0054). There was no statistically significant difference in total hospital stay opioid requirement but median length of stay was increased by 1 day. Conclusions: Preoperative administration of ITO reduced IV opioid requirement in the first 12 hours postoperatively but was associated with median 1 day increase in hospital stay.http://www.sciencedirect.com/science/article/pii/S2352578921001624Intrathecal opioidPostoperative painGynecologic oncologyExploratory laparotomy |
| spellingShingle | Yevgeniya Ioffe Ruofan Yao Eileen Hou Michelle Wheeler Mohamed Nour Wei Yun Wang Linda Hong One shot to control Pain: Decreasing postoperative opioid use in gynecologic oncology patients with intrathecal opioid injection Gynecologic Oncology Reports Intrathecal opioid Postoperative pain Gynecologic oncology Exploratory laparotomy |
| title | One shot to control Pain: Decreasing postoperative opioid use in gynecologic oncology patients with intrathecal opioid injection |
| title_full | One shot to control Pain: Decreasing postoperative opioid use in gynecologic oncology patients with intrathecal opioid injection |
| title_fullStr | One shot to control Pain: Decreasing postoperative opioid use in gynecologic oncology patients with intrathecal opioid injection |
| title_full_unstemmed | One shot to control Pain: Decreasing postoperative opioid use in gynecologic oncology patients with intrathecal opioid injection |
| title_short | One shot to control Pain: Decreasing postoperative opioid use in gynecologic oncology patients with intrathecal opioid injection |
| title_sort | one shot to control pain decreasing postoperative opioid use in gynecologic oncology patients with intrathecal opioid injection |
| topic | Intrathecal opioid Postoperative pain Gynecologic oncology Exploratory laparotomy |
| url | http://www.sciencedirect.com/science/article/pii/S2352578921001624 |
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