Multimodal Analgesia After Colorectal Surgery: Quantifying the Decrease in Opioid Consumption
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RESEARCH COMMUNICATION
Multimodal Analgesia After Colorectal Surgery: Quantifying the Decrease in Opioid Consumption Jackly M. Juprasert 1 & Christina Kwock 2 & Sarita S. Ballakur 1 & Lama Obeid 1 & Mohammad Piracha 3 & Heather L. Yeo 1,4 Received: 15 July 2020 / Accepted: 20 September 2020 # 2020 The Society for Surgery of the Alimentary Tract
Introduction Persistent opioid use after surgery may represent an overlooked complication contributing to the opioid epidemic. We aim to quantify the amount of postoperative opioid consumption in patients undergoing laparoscopic colectomy between 2014 to 2018 receiving varying types of non-opioid analgesia.
of non-opioid analgesics. The types of non-opioid analgesics include acetaminophen, nonsteroidal anti-inflammatory drugs, and gabapentin. All opioids administered 72 h postoperatively were converted to oral milligram morphine equivalents (MME) for comparison. ANOVA was employed to analyze continuous variables and the Student’s t test was used for sub-group analysis. Pearson’s Chi-square test and Fisher’s exact test were utilized to analyze discrete variables. All analyses were conducted with the use of R (v 3.6.1).
Methods A retrospective analysis was performed using a prospectively collected database of patients undergoing laparoscopic colectomy from February 2014 to June 2018 from 3 hospitals within the NewYork-Presbyterian (NYP) health system. Patients were separated into 3 cohorts according to the types of non-opioid analgesics administered: none, 1 to 2, or 3 types
Scientific meeting presentation: Juprasert J., Yeo H. "Varying Multimodal Analgesia Compliance with ERAS & Impact on Opioid Consumption Post-Colectomy” ePresentation at Digestive Disease Week; May 2, 2020. 169.2020. * Heather L. Yeo [email protected] 1
Department of Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, 525 East 68th Street, Box 172, New York, NY 10065, USA
2
Department of Surgery, NewYork-Presbyterian Hospital/Brooklyn Methodist Hospital, New York, NY, USA
3
Department of Anesthesiology, NewYork-Presbyterian Hospital/ Weill Cornell Medicine, New York, NY, USA
4
Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA
Results A total of 505 patients undergoing laparoscopic colectomy were identified and included in the analysis. There were 118 patients categorized into cohort 1 (zero non-opioid analgesics administered) (23%), 279 to cohort 2 (1 or 2 types of nonopioid analgesics administered) (55%), and 108 to cohort 3 (3 types of non-opioid analgesics administered) (21%). During the immediate 72 h after surgery, cohort 3 consumed the least MME at 416 (± 1063), and cohort 1 consumed the most at 1140 (± 1349) (p < 0.001) (Table 1). During the first 24 h after surgery (POD0), cohort 2 had the lowest MME at 180 (± 337) (p < 0.001) (Fig. 1). After POD1, cohort 3 had the lowest MME for POD1 at 130 (± 304) and POD2 at 65 (± 191) (p < 0.001). Cohort 1 had more patients with epidurals (n = 68, 58%) (p < 0.001). There was no difference in the
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