Reduced postoperative pain scores and narcotic use favor per-oral endoscopic myotomy over laparoscopic Heller myotomy
Introduction Per-oral endoscopic myotomy (POEM) is a less invasive therapy for achalasia with a shorter hospitalization but with similar short- and long-term outcomes as a laparoscopic Heller myotomy (LHM). Previous literature comparing POEM to LHM has focused primarily on postoperative outcome para...
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| description | Introduction
Per-oral endoscopic myotomy (POEM) is a less invasive therapy for achalasia with a shorter hospitalization but with similar short- and long-term outcomes as a laparoscopic Heller myotomy (LHM). Previous literature comparing POEM to LHM has focused primarily on postoperative outcome parameters such as complications, dysphagia scores and gastro-esophageal reflux severity. This study specifically compares postoperative pain following POEM to pain following LHM, the current gold-standard operation.
Methods
A retrospective review of all patients undergoing POEM or LHM for achalasia was performed from 2006 to 2015. Data collection included demographics, comorbidities, length of stay (LOS) and pain scores (arrival to the recovery room, 1 h postoperative, average first 24 h and upon discharge). Statistical analysis was performed using Student’s
t
test and Chi-square test.
Results
Forty-four POEM patients and 122 LHM patients were identified. The average age (52.2 ± 20.75 vs 50.9 ± 17.89 years,
p
= 0.306) and BMI (28.1 ± 7.62 vs 27.6 ± 7.07 kg/m
2
,
p
= 0.824) did not differ between the POEM and LHM groups, respectively; however, the American Society of Anesthesiology scores were higher in the POEM patients (2.43 ± 0.62 vs 2.11 ± 0.71,
p
= 0.011). There were no differences in rates of smoking, diabetes, cardiac disease or pulmonary disease. The average pain scores upon arrival to the recovery room and 1 h postoperatively were lower in the POEM group (2.3 ± 3.014 vs 3.61 ± 3 0.418,
p
= 0.025 and 2.2 ± 2.579 vs 3.46 ± 3.063,
p
= 0.034, respectively). There was no difference in the average pain score over the first 24 h (2.7 ± 2.067 vs 3.29 ± 1.980,
p
= 0.472) or at the time of discharge (1.6 ± 2.420 vs 2.09 ± 2.157,
p
= 0.0657) between the POEM and LHM groups. After standardizing opioid administration against 10 mg of oral morphine, the POEM group used significantly less narcotics that the LHM group (35.8 vs 101.8 mg,
p
|
| doi_str_mv | 10.1007/s00464-016-5034-3 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1826707729</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1826707729</sourcerecordid><originalsourceid>FETCH-LOGICAL-c438t-8df3a0d03ae2ce806fbfe221bafd5648847c0f7e582f5ad6583f97910776cf5e3</originalsourceid><addsrcrecordid>eNp10U2LFDEQBuAgiju7-gO8SMCLl2jlq5M-yrK6woIgeg6ZpCK9dHfapHtg_r1ZZlYWwVMg9aRSxUvIGw4fOID5WAFUpxjwjmmQislnZMeVFEwIbp-THfQSmDC9uiCXtd5D4z3XL8mFMFJabWFHtu8Yt4CRLrmuecHi1-GAdPHDTGvIBSv1c6SzLyGvQ6BbRZr8IRfaLMvFjxTnmBtdWnU65jVPR5oPWOjoF18eK7c4ju3uDF6RF8mPFV-fzyvy8_PNj-tbdvfty9frT3csKGlXZmOSHiJIjyKghS7tE7bd9j5F3SlrlQmQDGorkvax01am3vQcjOlC0iivyPtT36Xk3xvW1U1DDW0UP2PequNWdKZp0Tf67h96n7cyt-ma6rTQBpRoip9UaJvVgsktZZh8OToO7iETd8rEtUzcQyZOtjdvz523_YTx74vHEBoQJ1Bbaf6F5cnX_-36B40rmPg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1865257042</pqid></control><display><type>article</type><title>Reduced postoperative pain scores and narcotic use favor per-oral endoscopic myotomy over laparoscopic Heller myotomy</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Docimo, Salvatore ; Mathew, Abraham ; Shope, Alexander J. ; Winder, Joshua S. ; Haluck, Randy S. ; Pauli, Eric M.</creator><creatorcontrib>Docimo, Salvatore ; Mathew, Abraham ; Shope, Alexander J. ; Winder, Joshua S. ; Haluck, Randy S. ; Pauli, Eric M.</creatorcontrib><description>Introduction
Per-oral endoscopic myotomy (POEM) is a less invasive therapy for achalasia with a shorter hospitalization but with similar short- and long-term outcomes as a laparoscopic Heller myotomy (LHM). Previous literature comparing POEM to LHM has focused primarily on postoperative outcome parameters such as complications, dysphagia scores and gastro-esophageal reflux severity. This study specifically compares postoperative pain following POEM to pain following LHM, the current gold-standard operation.
Methods
A retrospective review of all patients undergoing POEM or LHM for achalasia was performed from 2006 to 2015. Data collection included demographics, comorbidities, length of stay (LOS) and pain scores (arrival to the recovery room, 1 h postoperative, average first 24 h and upon discharge). Statistical analysis was performed using Student’s
t
test and Chi-square test.
Results
Forty-four POEM patients and 122 LHM patients were identified. The average age (52.2 ± 20.75 vs 50.9 ± 17.89 years,
p
= 0.306) and BMI (28.1 ± 7.62 vs 27.6 ± 7.07 kg/m
2
,
p
= 0.824) did not differ between the POEM and LHM groups, respectively; however, the American Society of Anesthesiology scores were higher in the POEM patients (2.43 ± 0.62 vs 2.11 ± 0.71,
p
= 0.011). There were no differences in rates of smoking, diabetes, cardiac disease or pulmonary disease. The average pain scores upon arrival to the recovery room and 1 h postoperatively were lower in the POEM group (2.3 ± 3.014 vs 3.61 ± 3 0.418,
p
= 0.025 and 2.2 ± 2.579 vs 3.46 ± 3.063,
p
= 0.034, respectively). There was no difference in the average pain score over the first 24 h (2.7 ± 2.067 vs 3.29 ± 1.980,
p
= 0.472) or at the time of discharge (1.6 ± 2.420 vs 2.09 ± 2.157,
p
= 0.0657) between the POEM and LHM groups. After standardizing opioid administration against 10 mg of oral morphine, the POEM group used significantly less narcotics that the LHM group (35.8 vs 101.8 mg,
p
< 0.001) while hospitalized. The average LOS for the POEM group was 31.2 h and 55.79 for the LHM group (
p
< 0.0001). At discharge, fewer POEM patients required a prescription for a narcotic analgesic (6.81 vs 92.4 %,
p
< 0.0001).
Conclusion
POEM demonstrated significantly less postoperative pain upon arrival to the recovery room and 1 h postoperatively. To achieve similar pain scores during the first 24 h and at discharge, LHM patients required more narcotic analgesic administration. Despite a significantly shorter LOS, fewer POEM patients require a prescription for narcotic analgesics compared to LHM. POEM is a less painful procedure for achalasia than LHM, permitting earlier hospital discharge with little need for home narcotic use.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-016-5034-3</identifier><identifier>PMID: 27338580</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdomen ; Abdominal Surgery ; Administration, Oral ; Adult ; Aged ; Analgesics ; Analgesics, Opioid - therapeutic use ; Anesthesiology ; Body mass index ; Botulinum toxin ; Chi-Square Distribution ; Chronic obstructive pulmonary disease ; Deglutition Disorders - etiology ; Deglutition Disorders - surgery ; Diabetes ; Dysphagia ; Endoscopy ; Esophageal Achalasia - complications ; Esophageal Achalasia - surgery ; Esophageal Sphincter, Lower - surgery ; Esophagoscopy - methods ; Esophagus ; Female ; Gastroenterology ; Gastroesophageal Reflux - epidemiology ; Gastrointestinal surgery ; Gynecology ; Hepatology ; Hernias ; Humans ; Laparoscopy ; Laparoscopy - methods ; Length of Stay ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Narcotics ; Pain ; Pain Measurement ; Pain, Postoperative - drug therapy ; Pain, Postoperative - physiopathology ; Patients ; Postoperative Period ; Proctology ; Retrospective Studies ; Surgeons ; Surgery ; Treatment Outcome</subject><ispartof>Surgical endoscopy, 2017-02, Vol.31 (2), p.795-800</ispartof><rights>Springer Science+Business Media New York 2016</rights><rights>Surgical Endoscopy is a copyright of Springer, 2017.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c438t-8df3a0d03ae2ce806fbfe221bafd5648847c0f7e582f5ad6583f97910776cf5e3</citedby><cites>FETCH-LOGICAL-c438t-8df3a0d03ae2ce806fbfe221bafd5648847c0f7e582f5ad6583f97910776cf5e3</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/s00464-016-5034-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-016-5034-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,782,786,27931,27932,41495,42564,51326</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27338580$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Docimo, Salvatore</creatorcontrib><creatorcontrib>Mathew, Abraham</creatorcontrib><creatorcontrib>Shope, Alexander J.</creatorcontrib><creatorcontrib>Winder, Joshua S.</creatorcontrib><creatorcontrib>Haluck, Randy S.</creatorcontrib><creatorcontrib>Pauli, Eric M.</creatorcontrib><title>Reduced postoperative pain scores and narcotic use favor per-oral endoscopic myotomy over laparoscopic Heller myotomy</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Introduction
Per-oral endoscopic myotomy (POEM) is a less invasive therapy for achalasia with a shorter hospitalization but with similar short- and long-term outcomes as a laparoscopic Heller myotomy (LHM). Previous literature comparing POEM to LHM has focused primarily on postoperative outcome parameters such as complications, dysphagia scores and gastro-esophageal reflux severity. This study specifically compares postoperative pain following POEM to pain following LHM, the current gold-standard operation.
Methods
A retrospective review of all patients undergoing POEM or LHM for achalasia was performed from 2006 to 2015. Data collection included demographics, comorbidities, length of stay (LOS) and pain scores (arrival to the recovery room, 1 h postoperative, average first 24 h and upon discharge). Statistical analysis was performed using Student’s
t
test and Chi-square test.
Results
Forty-four POEM patients and 122 LHM patients were identified. The average age (52.2 ± 20.75 vs 50.9 ± 17.89 years,
p
= 0.306) and BMI (28.1 ± 7.62 vs 27.6 ± 7.07 kg/m
2
,
p
= 0.824) did not differ between the POEM and LHM groups, respectively; however, the American Society of Anesthesiology scores were higher in the POEM patients (2.43 ± 0.62 vs 2.11 ± 0.71,
p
= 0.011). There were no differences in rates of smoking, diabetes, cardiac disease or pulmonary disease. The average pain scores upon arrival to the recovery room and 1 h postoperatively were lower in the POEM group (2.3 ± 3.014 vs 3.61 ± 3 0.418,
p
= 0.025 and 2.2 ± 2.579 vs 3.46 ± 3.063,
p
= 0.034, respectively). There was no difference in the average pain score over the first 24 h (2.7 ± 2.067 vs 3.29 ± 1.980,
p
= 0.472) or at the time of discharge (1.6 ± 2.420 vs 2.09 ± 2.157,
p
= 0.0657) between the POEM and LHM groups. After standardizing opioid administration against 10 mg of oral morphine, the POEM group used significantly less narcotics that the LHM group (35.8 vs 101.8 mg,
p
< 0.001) while hospitalized. The average LOS for the POEM group was 31.2 h and 55.79 for the LHM group (
p
< 0.0001). At discharge, fewer POEM patients required a prescription for a narcotic analgesic (6.81 vs 92.4 %,
p
< 0.0001).
Conclusion
POEM demonstrated significantly less postoperative pain upon arrival to the recovery room and 1 h postoperatively. To achieve similar pain scores during the first 24 h and at discharge, LHM patients required more narcotic analgesic administration. Despite a significantly shorter LOS, fewer POEM patients require a prescription for narcotic analgesics compared to LHM. POEM is a less painful procedure for achalasia than LHM, permitting earlier hospital discharge with little need for home narcotic use.</description><subject>Abdomen</subject><subject>Abdominal Surgery</subject><subject>Administration, Oral</subject><subject>Adult</subject><subject>Aged</subject><subject>Analgesics</subject><subject>Analgesics, Opioid - therapeutic use</subject><subject>Anesthesiology</subject><subject>Body mass index</subject><subject>Botulinum toxin</subject><subject>Chi-Square Distribution</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Deglutition Disorders - etiology</subject><subject>Deglutition Disorders - surgery</subject><subject>Diabetes</subject><subject>Dysphagia</subject><subject>Endoscopy</subject><subject>Esophageal Achalasia - complications</subject><subject>Esophageal Achalasia - surgery</subject><subject>Esophageal Sphincter, Lower - surgery</subject><subject>Esophagoscopy - methods</subject><subject>Esophagus</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Gastroesophageal Reflux - epidemiology</subject><subject>Gastrointestinal surgery</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Hernias</subject><subject>Humans</subject><subject>Laparoscopy</subject><subject>Laparoscopy - methods</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Narcotics</subject><subject>Pain</subject><subject>Pain Measurement</subject><subject>Pain, Postoperative - drug therapy</subject><subject>Pain, Postoperative - physiopathology</subject><subject>Patients</subject><subject>Postoperative Period</subject><subject>Proctology</subject><subject>Retrospective Studies</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp10U2LFDEQBuAgiju7-gO8SMCLl2jlq5M-yrK6woIgeg6ZpCK9dHfapHtg_r1ZZlYWwVMg9aRSxUvIGw4fOID5WAFUpxjwjmmQislnZMeVFEwIbp-THfQSmDC9uiCXtd5D4z3XL8mFMFJabWFHtu8Yt4CRLrmuecHi1-GAdPHDTGvIBSv1c6SzLyGvQ6BbRZr8IRfaLMvFjxTnmBtdWnU65jVPR5oPWOjoF18eK7c4ju3uDF6RF8mPFV-fzyvy8_PNj-tbdvfty9frT3csKGlXZmOSHiJIjyKghS7tE7bd9j5F3SlrlQmQDGorkvax01am3vQcjOlC0iivyPtT36Xk3xvW1U1DDW0UP2PequNWdKZp0Tf67h96n7cyt-ma6rTQBpRoip9UaJvVgsktZZh8OToO7iETd8rEtUzcQyZOtjdvz523_YTx74vHEBoQJ1Bbaf6F5cnX_-36B40rmPg</recordid><startdate>20170201</startdate><enddate>20170201</enddate><creator>Docimo, Salvatore</creator><creator>Mathew, Abraham</creator><creator>Shope, Alexander J.</creator><creator>Winder, Joshua S.</creator><creator>Haluck, Randy S.</creator><creator>Pauli, Eric M.</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>20170201</creationdate><title>Reduced postoperative pain scores and narcotic use favor per-oral endoscopic myotomy over laparoscopic Heller myotomy</title><author>Docimo, Salvatore ; Mathew, Abraham ; Shope, Alexander J. ; Winder, Joshua S. ; Haluck, Randy S. ; Pauli, Eric M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c438t-8df3a0d03ae2ce806fbfe221bafd5648847c0f7e582f5ad6583f97910776cf5e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Abdomen</topic><topic>Abdominal Surgery</topic><topic>Administration, Oral</topic><topic>Adult</topic><topic>Aged</topic><topic>Analgesics</topic><topic>Analgesics, Opioid - therapeutic use</topic><topic>Anesthesiology</topic><topic>Body mass index</topic><topic>Botulinum toxin</topic><topic>Chi-Square Distribution</topic><topic>Chronic obstructive pulmonary disease</topic><topic>Deglutition Disorders - etiology</topic><topic>Deglutition Disorders - surgery</topic><topic>Diabetes</topic><topic>Dysphagia</topic><topic>Endoscopy</topic><topic>Esophageal Achalasia - complications</topic><topic>Esophageal Achalasia - surgery</topic><topic>Esophageal Sphincter, Lower - surgery</topic><topic>Esophagoscopy - methods</topic><topic>Esophagus</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>Gastroesophageal Reflux - epidemiology</topic><topic>Gastrointestinal surgery</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Hernias</topic><topic>Humans</topic><topic>Laparoscopy</topic><topic>Laparoscopy - methods</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Narcotics</topic><topic>Pain</topic><topic>Pain Measurement</topic><topic>Pain, Postoperative - drug therapy</topic><topic>Pain, Postoperative - physiopathology</topic><topic>Patients</topic><topic>Postoperative Period</topic><topic>Proctology</topic><topic>Retrospective Studies</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Docimo, Salvatore</creatorcontrib><creatorcontrib>Mathew, Abraham</creatorcontrib><creatorcontrib>Shope, Alexander J.</creatorcontrib><creatorcontrib>Winder, Joshua S.</creatorcontrib><creatorcontrib>Haluck, Randy S.</creatorcontrib><creatorcontrib>Pauli, Eric M.</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>Nursing & Allied Health Database</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>Docimo, Salvatore</au><au>Mathew, Abraham</au><au>Shope, Alexander J.</au><au>Winder, Joshua S.</au><au>Haluck, Randy S.</au><au>Pauli, Eric M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Reduced postoperative pain scores and narcotic use favor per-oral endoscopic myotomy over laparoscopic Heller myotomy</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2017-02-01</date><risdate>2017</risdate><volume>31</volume><issue>2</issue><spage>795</spage><epage>800</epage><pages>795-800</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Introduction
Per-oral endoscopic myotomy (POEM) is a less invasive therapy for achalasia with a shorter hospitalization but with similar short- and long-term outcomes as a laparoscopic Heller myotomy (LHM). Previous literature comparing POEM to LHM has focused primarily on postoperative outcome parameters such as complications, dysphagia scores and gastro-esophageal reflux severity. This study specifically compares postoperative pain following POEM to pain following LHM, the current gold-standard operation.
Methods
A retrospective review of all patients undergoing POEM or LHM for achalasia was performed from 2006 to 2015. Data collection included demographics, comorbidities, length of stay (LOS) and pain scores (arrival to the recovery room, 1 h postoperative, average first 24 h and upon discharge). Statistical analysis was performed using Student’s
t
test and Chi-square test.
Results
Forty-four POEM patients and 122 LHM patients were identified. The average age (52.2 ± 20.75 vs 50.9 ± 17.89 years,
p
= 0.306) and BMI (28.1 ± 7.62 vs 27.6 ± 7.07 kg/m
2
,
p
= 0.824) did not differ between the POEM and LHM groups, respectively; however, the American Society of Anesthesiology scores were higher in the POEM patients (2.43 ± 0.62 vs 2.11 ± 0.71,
p
= 0.011). There were no differences in rates of smoking, diabetes, cardiac disease or pulmonary disease. The average pain scores upon arrival to the recovery room and 1 h postoperatively were lower in the POEM group (2.3 ± 3.014 vs 3.61 ± 3 0.418,
p
= 0.025 and 2.2 ± 2.579 vs 3.46 ± 3.063,
p
= 0.034, respectively). There was no difference in the average pain score over the first 24 h (2.7 ± 2.067 vs 3.29 ± 1.980,
p
= 0.472) or at the time of discharge (1.6 ± 2.420 vs 2.09 ± 2.157,
p
= 0.0657) between the POEM and LHM groups. After standardizing opioid administration against 10 mg of oral morphine, the POEM group used significantly less narcotics that the LHM group (35.8 vs 101.8 mg,
p
< 0.001) while hospitalized. The average LOS for the POEM group was 31.2 h and 55.79 for the LHM group (
p
< 0.0001). At discharge, fewer POEM patients required a prescription for a narcotic analgesic (6.81 vs 92.4 %,
p
< 0.0001).
Conclusion
POEM demonstrated significantly less postoperative pain upon arrival to the recovery room and 1 h postoperatively. To achieve similar pain scores during the first 24 h and at discharge, LHM patients required more narcotic analgesic administration. Despite a significantly shorter LOS, fewer POEM patients require a prescription for narcotic analgesics compared to LHM. POEM is a less painful procedure for achalasia than LHM, permitting earlier hospital discharge with little need for home narcotic use.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>27338580</pmid><doi>10.1007/s00464-016-5034-3</doi><tpages>6</tpages></addata></record> |
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| subjects | Abdomen Abdominal Surgery Administration, Oral Adult Aged Analgesics Analgesics, Opioid - therapeutic use Anesthesiology Body mass index Botulinum toxin Chi-Square Distribution Chronic obstructive pulmonary disease Deglutition Disorders - etiology Deglutition Disorders - surgery Diabetes Dysphagia Endoscopy Esophageal Achalasia - complications Esophageal Achalasia - surgery Esophageal Sphincter, Lower - surgery Esophagoscopy - methods Esophagus Female Gastroenterology Gastroesophageal Reflux - epidemiology Gastrointestinal surgery Gynecology Hepatology Hernias Humans Laparoscopy Laparoscopy - methods Length of Stay Male Medicine Medicine & Public Health Middle Aged Narcotics Pain Pain Measurement Pain, Postoperative - drug therapy Pain, Postoperative - physiopathology Patients Postoperative Period Proctology Retrospective Studies Surgeons Surgery Treatment Outcome |
| title | Reduced postoperative pain scores and narcotic use favor per-oral endoscopic myotomy over laparoscopic Heller myotomy |
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