Optimization of an Enhanced Recovery After Surgery protocol for opioid-free pain management following robotic thoracic surgeryCentral MessagePerspectives
Objectives: Our Enhanced Recovery After Thoracic Surgery protocol was implemented on February 1, 2018, and firmly established 7 months later. We instituted protocol modifications on January 1, 2020, aiming to further reduce postoperative opioid consumption. We sought to evaluate the influence of suc...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-03-01
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| Series: | JTCVS Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666273622000043 |
| _version_ | 1811337304841650176 |
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| author | Karishma Kodia, MD Ahmed Alnajar, MD Joanne Szewczyk, MD Joy Stephens-McDonnough, MsN Nestor R. Villamizar, MD Dao M. Nguyen, MD, MSc, FRCSC, FACS |
| author_facet | Karishma Kodia, MD Ahmed Alnajar, MD Joanne Szewczyk, MD Joy Stephens-McDonnough, MsN Nestor R. Villamizar, MD Dao M. Nguyen, MD, MSc, FRCSC, FACS |
| author_sort | Karishma Kodia, MD |
| collection | DOAJ |
| description | Objectives: Our Enhanced Recovery After Thoracic Surgery protocol was implemented on February 1, 2018, and firmly established 7 months later. We instituted protocol modifications on January 1, 2020, aiming to further reduce postoperative opioid consumption. We sought to evaluate the influence of such efforts on clinical outcomes and the use of both schedule II and schedule IV opioids following robotic thoracoscopic procedures. Methods: A retrospective study of patients undergoing elective robotic procedures between September 1, 2018, and December 31, 2020, was conducted. Essential components of pain management in the original protocol included nonopioid analgesics, intercostal nerve blocks with long-acting liposomal bupivacaine diluted with normal saline, and opioids (ie, scheduled tramadol administration and as-needed schedule II narcotics). Protocol optimization included replacing saline diluent with 0.25% bupivacaine and switching tramadol to as needed, keeping other aspects unchanged. Demographic characteristics, type of robotic procedures, postoperative outcomes, and in-hospital and postdischarge opioids prescribed (ie, milligrams of morphine equivalent [MME]) were extracted from electronic medical records. Results: Three hundred twenty-four patients met the inclusion criteria (159 in the original and 183 in the optimized protocol). There was no difference in postoperative outcomes or acute postoperative pain; there was a significant reduction of in-hospital and postdischarge opioid requirements in the optimized cohort. For anatomic resections: mean, 60.0 MME (range, 0-60.0 MME) versus mean, 105.0 MME (range, 60.0-150.0 MME), and other procedures: mean, 0 MME (range, 0-60 MME) versus mean, 140.0 (range, 60.0-150.0 MME) (P < .00001) with median schedule II opioids prescribed = 0. Conclusions: Small modifications to our protocol for pain management strategies are safe and associated with significant decrease of opioid requirements, particularly schedule II narcotics, during the postoperative period without influencing acute pain levels. |
| first_indexed | 2024-04-13T17:52:54Z |
| format | Article |
| id | doaj.art-f5ca7f65bfb1453c929e354360abf421 |
| institution | Directory Open Access Journal |
| issn | 2666-2736 |
| language | English |
| last_indexed | 2024-04-13T17:52:54Z |
| publishDate | 2022-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj.art-f5ca7f65bfb1453c929e354360abf4212022-12-22T02:36:38ZengElsevierJTCVS Open2666-27362022-03-019317328Optimization of an Enhanced Recovery After Surgery protocol for opioid-free pain management following robotic thoracic surgeryCentral MessagePerspectivesKarishma Kodia, MD0Ahmed Alnajar, MD1Joanne Szewczyk, MD2Joy Stephens-McDonnough, MsN3Nestor R. Villamizar, MD4Dao M. Nguyen, MD, MSc, FRCSC, FACS5Section of Thoracic Surgery, Division of Cardiothoracic Surgery, The DeWitt Daughtry Department of Surgery, University of Miami, Miami, FlaSection of Thoracic Surgery, Division of Cardiothoracic Surgery, The DeWitt Daughtry Department of Surgery, University of Miami, Miami, FlaSection of Thoracic Surgery, Division of Cardiothoracic Surgery, The DeWitt Daughtry Department of Surgery, University of Miami, Miami, FlaSection of Thoracic Surgery, Division of Cardiothoracic Surgery, The DeWitt Daughtry Department of Surgery, University of Miami, Miami, FlaSection of Thoracic Surgery, Division of Cardiothoracic Surgery, The DeWitt Daughtry Department of Surgery, University of Miami, Miami, FlaAddress for reprints: Dao M. Nguyen, MD, MSc, FRCSC, FACS, Section of Thoracic Surgery, Division of Cardiothoracic Surgery, The DeWitt Daughtry Department of Surgery, University of Miami, 1295 NW 14th St, Suite J, Miami, FL 33136.; Section of Thoracic Surgery, Division of Cardiothoracic Surgery, The DeWitt Daughtry Department of Surgery, University of Miami, Miami, FlaObjectives: Our Enhanced Recovery After Thoracic Surgery protocol was implemented on February 1, 2018, and firmly established 7 months later. We instituted protocol modifications on January 1, 2020, aiming to further reduce postoperative opioid consumption. We sought to evaluate the influence of such efforts on clinical outcomes and the use of both schedule II and schedule IV opioids following robotic thoracoscopic procedures. Methods: A retrospective study of patients undergoing elective robotic procedures between September 1, 2018, and December 31, 2020, was conducted. Essential components of pain management in the original protocol included nonopioid analgesics, intercostal nerve blocks with long-acting liposomal bupivacaine diluted with normal saline, and opioids (ie, scheduled tramadol administration and as-needed schedule II narcotics). Protocol optimization included replacing saline diluent with 0.25% bupivacaine and switching tramadol to as needed, keeping other aspects unchanged. Demographic characteristics, type of robotic procedures, postoperative outcomes, and in-hospital and postdischarge opioids prescribed (ie, milligrams of morphine equivalent [MME]) were extracted from electronic medical records. Results: Three hundred twenty-four patients met the inclusion criteria (159 in the original and 183 in the optimized protocol). There was no difference in postoperative outcomes or acute postoperative pain; there was a significant reduction of in-hospital and postdischarge opioid requirements in the optimized cohort. For anatomic resections: mean, 60.0 MME (range, 0-60.0 MME) versus mean, 105.0 MME (range, 60.0-150.0 MME), and other procedures: mean, 0 MME (range, 0-60 MME) versus mean, 140.0 (range, 60.0-150.0 MME) (P < .00001) with median schedule II opioids prescribed = 0. Conclusions: Small modifications to our protocol for pain management strategies are safe and associated with significant decrease of opioid requirements, particularly schedule II narcotics, during the postoperative period without influencing acute pain levels.http://www.sciencedirect.com/science/article/pii/S2666273622000043ERATSrobotic surgeryintercostal nerve blockpostoperative painpostoperative opioid utilization |
| spellingShingle | Karishma Kodia, MD Ahmed Alnajar, MD Joanne Szewczyk, MD Joy Stephens-McDonnough, MsN Nestor R. Villamizar, MD Dao M. Nguyen, MD, MSc, FRCSC, FACS Optimization of an Enhanced Recovery After Surgery protocol for opioid-free pain management following robotic thoracic surgeryCentral MessagePerspectives JTCVS Open ERATS robotic surgery intercostal nerve block postoperative pain postoperative opioid utilization |
| title | Optimization of an Enhanced Recovery After Surgery protocol for opioid-free pain management following robotic thoracic surgeryCentral MessagePerspectives |
| title_full | Optimization of an Enhanced Recovery After Surgery protocol for opioid-free pain management following robotic thoracic surgeryCentral MessagePerspectives |
| title_fullStr | Optimization of an Enhanced Recovery After Surgery protocol for opioid-free pain management following robotic thoracic surgeryCentral MessagePerspectives |
| title_full_unstemmed | Optimization of an Enhanced Recovery After Surgery protocol for opioid-free pain management following robotic thoracic surgeryCentral MessagePerspectives |
| title_short | Optimization of an Enhanced Recovery After Surgery protocol for opioid-free pain management following robotic thoracic surgeryCentral MessagePerspectives |
| title_sort | optimization of an enhanced recovery after surgery protocol for opioid free pain management following robotic thoracic surgerycentral messageperspectives |
| topic | ERATS robotic surgery intercostal nerve block postoperative pain postoperative opioid utilization |
| url | http://www.sciencedirect.com/science/article/pii/S2666273622000043 |
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