Pilot study of a novel pain management strategy: evaluating the impact on patient outcomes
Background Our objective was to evaluate the impact of a novel multimodal pain management strategy on intraoperative opioid requirements, postoperative pain, narcotic use, and length of stay. Methods Consecutive patients undergoing elective laparoscopic colorectal resection were managed with an expe...
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| Veröffentlicht in: | Surgical endoscopy 2016-06, Vol.30 (6), p.2192-2198 |
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| creator | Keller, DS Tahilramani, RN Flores-Gonzalez, JR Ibarra, S. Haas, EM |
| description | Background
Our objective was to evaluate the impact of a novel multimodal pain management strategy on intraoperative opioid requirements, postoperative pain, narcotic use, and length of stay.
Methods
Consecutive patients undergoing elective laparoscopic colorectal resection were managed with an experimental protocol. The protocol uses a post-induction, pre-incision bilateral TAP block and local peritoneal infiltration at port sites with long-acting liposomal bupivacaine (20 mL long-acting liposomal bupivacaine, 30 mL 0.25 % bupivacaine, 30 mL saline). Experimental patients were matched on age, body mass index, gender, comorbidity, diagnosis, and procedure to a control group that received no block or local wound infiltration. Both groups followed a standardized enhanced recovery pathway. Demographics, perioperative, and postoperative outcomes were evaluated. The main outcome measures were intraoperative opioids, postoperative pain, opioid use, and length of stay.
Results
Fifty patients were analyzed—25 experimental and 25 controls. Patients were well matched on all demographics. In both cohorts, the main diagnosis was colorectal cancer and primary procedure performed a segmental resection. Operative times were similar (
p
= 0.41). Experimental patients received significantly less intraoperative fentanyl (mean 158 mcg experimental vs. 299 mcg control;
p
|
| doi_str_mv | 10.1007/s00464-015-4459-4 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1793568659</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1793568659</sourcerecordid><originalsourceid>FETCH-LOGICAL-c438t-89686254b608ee0b6c833a5b0d6227704aa36a03a13083b28d4546fbbc716b33</originalsourceid><addsrcrecordid>eNp1kE1Lw0AQhhdRbK3-AC-y4MVLdPYziTcpfkFBDz15WTbJtqYkuzW7KfTfuyEqIniawzzvO8OD0DmBawKQ3ngALnkCRCScizzhB2hKOKMJpSQ7RFPIGSQ0zfkEnXi_gYjnRByjCZU0FYLnU_T2WjcuYB_6ao_dCmts3c40eKtri1tt9dq0xg5Ap4NZ72-x2emm16G2axzeDa7brS4DdjZGQj2grg-la40_RUcr3Xhz9jVnaPlwv5w_JYuXx-f53SIpOctCkuUyk1TwQkJmDBSyzBjTooBKUpqmwLVmUgPThEHGCppVXHC5KooyJbJgbIauxtpt5z5644Nqa1-aptHWuN4rkuZMxBMij-jlH3Tj-s7G5waKphC1DIVkpMrOed-Zldp2dau7vSKgBu9q9K6idzV4VzxmLr6a-6I11U_iW3QE6Aj4uLJr0_06_W_rJ-BSjGk</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1792706273</pqid></control><display><type>article</type><title>Pilot study of a novel pain management strategy: evaluating the impact on patient outcomes</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Keller, DS ; Tahilramani, RN ; Flores-Gonzalez, JR ; Ibarra, S. ; Haas, EM</creator><creatorcontrib>Keller, DS ; Tahilramani, RN ; Flores-Gonzalez, JR ; Ibarra, S. ; Haas, EM</creatorcontrib><description>Background
Our objective was to evaluate the impact of a novel multimodal pain management strategy on intraoperative opioid requirements, postoperative pain, narcotic use, and length of stay.
Methods
Consecutive patients undergoing elective laparoscopic colorectal resection were managed with an experimental protocol. The protocol uses a post-induction, pre-incision bilateral TAP block and local peritoneal infiltration at port sites with long-acting liposomal bupivacaine (20 mL long-acting liposomal bupivacaine, 30 mL 0.25 % bupivacaine, 30 mL saline). Experimental patients were matched on age, body mass index, gender, comorbidity, diagnosis, and procedure to a control group that received no block or local wound infiltration. Both groups followed a standardized enhanced recovery pathway. Demographics, perioperative, and postoperative outcomes were evaluated. The main outcome measures were intraoperative opioids, postoperative pain, opioid use, and length of stay.
Results
Fifty patients were analyzed—25 experimental and 25 controls. Patients were well matched on all demographics. In both cohorts, the main diagnosis was colorectal cancer and primary procedure performed a segmental resection. Operative times were similar (
p
= 0.41). Experimental patients received significantly less intraoperative fentanyl (mean 158 mcg experimental vs. 299 mcg control;
p
< 0.01). The experimental group had significantly lower initial (
p
< 0.01) and final PACU pain scores (
p
= 0.04) and shorter LOS (3.0 vs. 4.1 days,
p
= 0.04) compared to controls. Experimental patients trended toward shorter PACU times and lower opioid use and daily pain scores throughout the hospital stay. Postoperative complication and readmission rates were similar across groups. There were no reoperations or mortality.
Conclusions
Our multimodal pain management strategy reduced intraoperative opioid administration. Postoperatively, improvements in PACU time, postoperative pain and narcotic use, and lengths of stay were seen in the experimental cohort. With the favorable finding from the pilot study, further investigation is warranted to fully evaluate the impact of this pain management protocol on patient satisfaction, clinical and financial outcomes.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-015-4459-4</identifier><identifier>PMID: 26275549</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject><![CDATA[Abdominal Surgery ; Analgesics, Opioid - administration & dosage ; Bupivacaine - administration & dosage ; Clinical outcomes ; Colonic Diseases - complications ; Colonic Diseases - physiopathology ; Colonic Diseases - surgery ; Colorectal Surgery ; Elective Surgical Procedures ; Female ; Fentanyl - administration & dosage ; Gastroenterology ; Gynecology ; Health services utilization ; Hepatology ; Hospitals ; Humans ; Laparoscopy ; Length of stay ; Length of Stay - statistics & numerical data ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Narcotics ; Operative Time ; Pain management ; Pain Management - methods ; Pain, Postoperative - drug therapy ; Patient Satisfaction ; Pharmacists ; Pilot Projects ; Proctology ; Recovery (Medical) ; Rectum - surgery ; Reoperation - statistics & numerical data ; Surgery ; Surgical outcomes ; Treatment Outcome]]></subject><ispartof>Surgical endoscopy, 2016-06, Vol.30 (6), p.2192-2198</ispartof><rights>Springer Science+Business Media New York 2015</rights><rights>Springer Science+Business Media New York 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c438t-89686254b608ee0b6c833a5b0d6227704aa36a03a13083b28d4546fbbc716b33</citedby><cites>FETCH-LOGICAL-c438t-89686254b608ee0b6c833a5b0d6227704aa36a03a13083b28d4546fbbc716b33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-015-4459-4$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-015-4459-4$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,781,785,27929,27930,41493,42562,51324</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26275549$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Keller, DS</creatorcontrib><creatorcontrib>Tahilramani, RN</creatorcontrib><creatorcontrib>Flores-Gonzalez, JR</creatorcontrib><creatorcontrib>Ibarra, S.</creatorcontrib><creatorcontrib>Haas, EM</creatorcontrib><title>Pilot study of a novel pain management strategy: evaluating the impact on patient outcomes</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
Our objective was to evaluate the impact of a novel multimodal pain management strategy on intraoperative opioid requirements, postoperative pain, narcotic use, and length of stay.
Methods
Consecutive patients undergoing elective laparoscopic colorectal resection were managed with an experimental protocol. The protocol uses a post-induction, pre-incision bilateral TAP block and local peritoneal infiltration at port sites with long-acting liposomal bupivacaine (20 mL long-acting liposomal bupivacaine, 30 mL 0.25 % bupivacaine, 30 mL saline). Experimental patients were matched on age, body mass index, gender, comorbidity, diagnosis, and procedure to a control group that received no block or local wound infiltration. Both groups followed a standardized enhanced recovery pathway. Demographics, perioperative, and postoperative outcomes were evaluated. The main outcome measures were intraoperative opioids, postoperative pain, opioid use, and length of stay.
Results
Fifty patients were analyzed—25 experimental and 25 controls. Patients were well matched on all demographics. In both cohorts, the main diagnosis was colorectal cancer and primary procedure performed a segmental resection. Operative times were similar (
p
= 0.41). Experimental patients received significantly less intraoperative fentanyl (mean 158 mcg experimental vs. 299 mcg control;
p
< 0.01). The experimental group had significantly lower initial (
p
< 0.01) and final PACU pain scores (
p
= 0.04) and shorter LOS (3.0 vs. 4.1 days,
p
= 0.04) compared to controls. Experimental patients trended toward shorter PACU times and lower opioid use and daily pain scores throughout the hospital stay. Postoperative complication and readmission rates were similar across groups. There were no reoperations or mortality.
Conclusions
Our multimodal pain management strategy reduced intraoperative opioid administration. Postoperatively, improvements in PACU time, postoperative pain and narcotic use, and lengths of stay were seen in the experimental cohort. With the favorable finding from the pilot study, further investigation is warranted to fully evaluate the impact of this pain management protocol on patient satisfaction, clinical and financial outcomes.</description><subject>Abdominal Surgery</subject><subject>Analgesics, Opioid - administration & dosage</subject><subject>Bupivacaine - administration & dosage</subject><subject>Clinical outcomes</subject><subject>Colonic Diseases - complications</subject><subject>Colonic Diseases - physiopathology</subject><subject>Colonic Diseases - surgery</subject><subject>Colorectal Surgery</subject><subject>Elective Surgical Procedures</subject><subject>Female</subject><subject>Fentanyl - administration & dosage</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Health services utilization</subject><subject>Hepatology</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Laparoscopy</subject><subject>Length of stay</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Narcotics</subject><subject>Operative Time</subject><subject>Pain management</subject><subject>Pain Management - methods</subject><subject>Pain, Postoperative - drug therapy</subject><subject>Patient Satisfaction</subject><subject>Pharmacists</subject><subject>Pilot Projects</subject><subject>Proctology</subject><subject>Recovery (Medical)</subject><subject>Rectum - surgery</subject><subject>Reoperation - statistics & numerical data</subject><subject>Surgery</subject><subject>Surgical outcomes</subject><subject>Treatment Outcome</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kE1Lw0AQhhdRbK3-AC-y4MVLdPYziTcpfkFBDz15WTbJtqYkuzW7KfTfuyEqIniawzzvO8OD0DmBawKQ3ngALnkCRCScizzhB2hKOKMJpSQ7RFPIGSQ0zfkEnXi_gYjnRByjCZU0FYLnU_T2WjcuYB_6ao_dCmts3c40eKtri1tt9dq0xg5Ap4NZ72-x2emm16G2axzeDa7brS4DdjZGQj2grg-la40_RUcr3Xhz9jVnaPlwv5w_JYuXx-f53SIpOctCkuUyk1TwQkJmDBSyzBjTooBKUpqmwLVmUgPThEHGCppVXHC5KooyJbJgbIauxtpt5z5644Nqa1-aptHWuN4rkuZMxBMij-jlH3Tj-s7G5waKphC1DIVkpMrOed-Zldp2dau7vSKgBu9q9K6idzV4VzxmLr6a-6I11U_iW3QE6Aj4uLJr0_06_W_rJ-BSjGk</recordid><startdate>20160601</startdate><enddate>20160601</enddate><creator>Keller, DS</creator><creator>Tahilramani, RN</creator><creator>Flores-Gonzalez, JR</creator><creator>Ibarra, S.</creator><creator>Haas, EM</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20160601</creationdate><title>Pilot study of a novel pain management strategy: evaluating the impact on patient outcomes</title><author>Keller, DS ; Tahilramani, RN ; Flores-Gonzalez, JR ; Ibarra, S. ; Haas, EM</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c438t-89686254b608ee0b6c833a5b0d6227704aa36a03a13083b28d4546fbbc716b33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Abdominal Surgery</topic><topic>Analgesics, Opioid - administration & dosage</topic><topic>Bupivacaine - administration & dosage</topic><topic>Clinical outcomes</topic><topic>Colonic Diseases - complications</topic><topic>Colonic Diseases - physiopathology</topic><topic>Colonic Diseases - surgery</topic><topic>Colorectal Surgery</topic><topic>Elective Surgical Procedures</topic><topic>Female</topic><topic>Fentanyl - administration & dosage</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Health services utilization</topic><topic>Hepatology</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Laparoscopy</topic><topic>Length of stay</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Narcotics</topic><topic>Operative Time</topic><topic>Pain management</topic><topic>Pain Management - methods</topic><topic>Pain, Postoperative - drug therapy</topic><topic>Patient Satisfaction</topic><topic>Pharmacists</topic><topic>Pilot Projects</topic><topic>Proctology</topic><topic>Recovery (Medical)</topic><topic>Rectum - surgery</topic><topic>Reoperation - statistics & numerical data</topic><topic>Surgery</topic><topic>Surgical outcomes</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Keller, DS</creatorcontrib><creatorcontrib>Tahilramani, RN</creatorcontrib><creatorcontrib>Flores-Gonzalez, JR</creatorcontrib><creatorcontrib>Ibarra, S.</creatorcontrib><creatorcontrib>Haas, EM</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Keller, DS</au><au>Tahilramani, RN</au><au>Flores-Gonzalez, JR</au><au>Ibarra, S.</au><au>Haas, EM</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pilot study of a novel pain management strategy: evaluating the impact on patient outcomes</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2016-06-01</date><risdate>2016</risdate><volume>30</volume><issue>6</issue><spage>2192</spage><epage>2198</epage><pages>2192-2198</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
Our objective was to evaluate the impact of a novel multimodal pain management strategy on intraoperative opioid requirements, postoperative pain, narcotic use, and length of stay.
Methods
Consecutive patients undergoing elective laparoscopic colorectal resection were managed with an experimental protocol. The protocol uses a post-induction, pre-incision bilateral TAP block and local peritoneal infiltration at port sites with long-acting liposomal bupivacaine (20 mL long-acting liposomal bupivacaine, 30 mL 0.25 % bupivacaine, 30 mL saline). Experimental patients were matched on age, body mass index, gender, comorbidity, diagnosis, and procedure to a control group that received no block or local wound infiltration. Both groups followed a standardized enhanced recovery pathway. Demographics, perioperative, and postoperative outcomes were evaluated. The main outcome measures were intraoperative opioids, postoperative pain, opioid use, and length of stay.
Results
Fifty patients were analyzed—25 experimental and 25 controls. Patients were well matched on all demographics. In both cohorts, the main diagnosis was colorectal cancer and primary procedure performed a segmental resection. Operative times were similar (
p
= 0.41). Experimental patients received significantly less intraoperative fentanyl (mean 158 mcg experimental vs. 299 mcg control;
p
< 0.01). The experimental group had significantly lower initial (
p
< 0.01) and final PACU pain scores (
p
= 0.04) and shorter LOS (3.0 vs. 4.1 days,
p
= 0.04) compared to controls. Experimental patients trended toward shorter PACU times and lower opioid use and daily pain scores throughout the hospital stay. Postoperative complication and readmission rates were similar across groups. There were no reoperations or mortality.
Conclusions
Our multimodal pain management strategy reduced intraoperative opioid administration. Postoperatively, improvements in PACU time, postoperative pain and narcotic use, and lengths of stay were seen in the experimental cohort. With the favorable finding from the pilot study, further investigation is warranted to fully evaluate the impact of this pain management protocol on patient satisfaction, clinical and financial outcomes.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>26275549</pmid><doi>10.1007/s00464-015-4459-4</doi><tpages>7</tpages></addata></record> |
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| subjects | Abdominal Surgery Analgesics, Opioid - administration & dosage Bupivacaine - administration & dosage Clinical outcomes Colonic Diseases - complications Colonic Diseases - physiopathology Colonic Diseases - surgery Colorectal Surgery Elective Surgical Procedures Female Fentanyl - administration & dosage Gastroenterology Gynecology Health services utilization Hepatology Hospitals Humans Laparoscopy Length of stay Length of Stay - statistics & numerical data Male Medicine Medicine & Public Health Middle Aged Narcotics Operative Time Pain management Pain Management - methods Pain, Postoperative - drug therapy Patient Satisfaction Pharmacists Pilot Projects Proctology Recovery (Medical) Rectum - surgery Reoperation - statistics & numerical data Surgery Surgical outcomes Treatment Outcome |
| title | Pilot study of a novel pain management strategy: evaluating the impact on patient outcomes |
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