Opioid-sparing anesthesia and patient-reported outcomes after open gynecologic surgery: a historical cohort study
Purpose Dexmedetomidine and ketamine may be administered intraoperatively as continuous infusions to provide opioid-sparing anesthesia. Recent evidence has yielded controversial results regarding the impact of opioid-free anesthesia on postoperative complications, and there is a gap in knowledge reg...
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| Veröffentlicht in: | Canadian journal of anesthesia 2022-12, Vol.69 (12), p.1477-1492 |
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| creator | Zorrilla-Vaca, Andres Ramirez, Pedro T. Iniesta-Donate, Maria Lasala, Javier D. Wang, Xin Shelley Williams, Loretta A. Meyer, Larissa Mena, Gabriel E. |
| description | Purpose
Dexmedetomidine and ketamine may be administered intraoperatively as continuous infusions to provide opioid-sparing anesthesia. Recent evidence has yielded controversial results regarding the impact of opioid-free anesthesia on postoperative complications, and there is a gap in knowledge regarding patient-reported outcomes (PROs). This study aimed to determine the impact of opioid-sparing anesthesia and opioid-based anesthesia on PROs among gynecologic patients within an enhanced recovery after surgery (ERAS) program.
Methods
We formed a single-center historical cohort from patients enrolled in another study who underwent open gynecologic surgery on an ERAS program from November 2014 to December 2020 (
n
= 2,095). We identified two cohorts based on the type of balanced anesthesia administered: 1) opioid-sparing anesthesia defined as the continuous infusion of dexmedetomidine and ketamine (adjuvants) during surgery or 2) opioid-based anesthesia (no adjuvants). We measured the quality of postoperative recovery using the MD Anderson Symptom Inventory (MDASI), a 29-item validated tool that was administered preoperatively, daily while admitted, and weekly after discharge until week 6. The primary outcome was interference with walking. We matched both cohorts and used a multilevel linear mixed-effect model to evaluate the effect of opioid-sparing anesthesia on the primary outcome.
Results
In total, 498 patients were eligible (159 in the opioid-sparing anesthesia cohort and 339 in the opioid-based anesthesia cohort), of whom 149 matched pairs were included in the final analysis. Longitudinal assessment showed no significant or clinically important difference in interference with walking (
P
= 0.99), general activity (
P
= 0.99), or other PROs between cohorts. Median [interquartile range (IQR)] intraoperative opioid administration (expressed as morphine milligram equivalents [MME]) among matched patients in the opioid-sparing anesthesia cohort was 30 [25–55] mg
vs
58 [8–70] mg in the opioid-based anesthesia cohort (
P
< 0.01). Patients in the opioid-sparing anesthesia cohort had a lower opioid consumption in the postanesthesia care unit than those in the opioid-based anesthesia cohort (MME, 3 [0–10] mg
vs
5 [0–15] mg;
P
< 0.01), but there was no significant difference between cohorts in total postoperative opioid consumption (MME, 23 [0–94] mg
vs
35 [13–95] mg
P
= 0.053).
Conclusions
In this single-center historical cohort study, opioid-sparing anesthesia |
| doi_str_mv | 10.1007/s12630-022-02336-8 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2724584289</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2737284854</sourcerecordid><originalsourceid>FETCH-LOGICAL-c419t-d67d12ee1104050faeacf8e019e7c45990ca099c3d44f9a5a5a8fcb7680fb8ce3</originalsourceid><addsrcrecordid>eNp9kU1r3DAQhkVoSDab_IEeiqCXXJyMPmxLvZXQfEBgLwn0JrTyeFfBazmSfNh_X6WbtNBDEUJzeN6RRg8hnxlcMYD2OjHeCKiA87KFaCp1RBZM6lLotv5EFqAErxoGP0_JWUovAKCaWp2QU9FwLmtoFuR1NfnguypNNvpxQ-2IKW8xeVvKjk42exxzFXEKMWNHw5xd2GGits8YaZhwpJv9iC4MYeMdTXPcYNx_o5ZufcohemcH6sK2xGnKc7c_J8e9HRJevJ9L8nz74-nmvnpc3T3cfH-snGQ6V13TdowjMgYSaugtWtcrBKaxdbLWGpwFrZ3opOy1rctSvVu3jYJ-rRyKJbk89J1ieJ3LVGbnk8NhKCOGORneli9Qkitd0K__oC9hjmN5XaFEy5VUtSwUP1AuhpQi9maKfmfj3jAwb0LMQYgpQsxvIUaV0Jf31vN6h92fyIeBAogDkKY3ARj_3v2ftr8A37-Yiw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2737284854</pqid></control><display><type>article</type><title>Opioid-sparing anesthesia and patient-reported outcomes after open gynecologic surgery: a historical cohort study</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Zorrilla-Vaca, Andres ; Ramirez, Pedro T. ; Iniesta-Donate, Maria ; Lasala, Javier D. ; Wang, Xin Shelley ; Williams, Loretta A. ; Meyer, Larissa ; Mena, Gabriel E.</creator><creatorcontrib>Zorrilla-Vaca, Andres ; Ramirez, Pedro T. ; Iniesta-Donate, Maria ; Lasala, Javier D. ; Wang, Xin Shelley ; Williams, Loretta A. ; Meyer, Larissa ; Mena, Gabriel E.</creatorcontrib><description>Purpose
Dexmedetomidine and ketamine may be administered intraoperatively as continuous infusions to provide opioid-sparing anesthesia. Recent evidence has yielded controversial results regarding the impact of opioid-free anesthesia on postoperative complications, and there is a gap in knowledge regarding patient-reported outcomes (PROs). This study aimed to determine the impact of opioid-sparing anesthesia and opioid-based anesthesia on PROs among gynecologic patients within an enhanced recovery after surgery (ERAS) program.
Methods
We formed a single-center historical cohort from patients enrolled in another study who underwent open gynecologic surgery on an ERAS program from November 2014 to December 2020 (
n
= 2,095). We identified two cohorts based on the type of balanced anesthesia administered: 1) opioid-sparing anesthesia defined as the continuous infusion of dexmedetomidine and ketamine (adjuvants) during surgery or 2) opioid-based anesthesia (no adjuvants). We measured the quality of postoperative recovery using the MD Anderson Symptom Inventory (MDASI), a 29-item validated tool that was administered preoperatively, daily while admitted, and weekly after discharge until week 6. The primary outcome was interference with walking. We matched both cohorts and used a multilevel linear mixed-effect model to evaluate the effect of opioid-sparing anesthesia on the primary outcome.
Results
In total, 498 patients were eligible (159 in the opioid-sparing anesthesia cohort and 339 in the opioid-based anesthesia cohort), of whom 149 matched pairs were included in the final analysis. Longitudinal assessment showed no significant or clinically important difference in interference with walking (
P
= 0.99), general activity (
P
= 0.99), or other PROs between cohorts. Median [interquartile range (IQR)] intraoperative opioid administration (expressed as morphine milligram equivalents [MME]) among matched patients in the opioid-sparing anesthesia cohort was 30 [25–55] mg
vs
58 [8–70] mg in the opioid-based anesthesia cohort (
P
< 0.01). Patients in the opioid-sparing anesthesia cohort had a lower opioid consumption in the postanesthesia care unit than those in the opioid-based anesthesia cohort (MME, 3 [0–10] mg
vs
5 [0–15] mg;
P
< 0.01), but there was no significant difference between cohorts in total postoperative opioid consumption (MME, 23 [0–94] mg
vs
35 [13–95] mg
P
= 0.053).
Conclusions
In this single-center historical cohort study, opioid-sparing anesthesia had no significant or clinically important effects on interference with walking or other PROs in patients undergoing gynecologic surgery compared with opioid-based anesthesia. Opioid-sparing anesthesia was associated with less short-term opioid consumption than opioid-based anesthesia.</description><identifier>ISSN: 0832-610X</identifier><identifier>EISSN: 1496-8975</identifier><identifier>DOI: 10.1007/s12630-022-02336-8</identifier><identifier>PMID: 36224506</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Analgesics, Opioid ; Anesthesia - adverse effects ; Anesthesiology ; Cardiology ; Clinical outcomes ; Cohort analysis ; Cohort Studies ; Critical Care Medicine ; Dexmedetomidine ; Female ; Gynecologic Surgical Procedures - methods ; Gynecological surgery ; Humans ; Intensive ; Ketamine ; Medicine ; Medicine & Public Health ; Morphine ; Narcotics ; Pain Medicine ; Pain, Postoperative - diagnosis ; Pain, Postoperative - drug therapy ; Patient Reported Outcome Measures ; Patients ; Pediatrics ; Pneumology/Respiratory System ; Recovery (Medical) ; Reports of Original Investigations</subject><ispartof>Canadian journal of anesthesia, 2022-12, Vol.69 (12), p.1477-1492</ispartof><rights>Canadian Anesthesiologists' Society 2022. Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2022. Canadian Anesthesiologists' Society.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c419t-d67d12ee1104050faeacf8e019e7c45990ca099c3d44f9a5a5a8fcb7680fb8ce3</citedby><cites>FETCH-LOGICAL-c419t-d67d12ee1104050faeacf8e019e7c45990ca099c3d44f9a5a5a8fcb7680fb8ce3</cites><orcidid>0000-0001-8140-8486</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s12630-022-02336-8$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s12630-022-02336-8$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51298</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36224506$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zorrilla-Vaca, Andres</creatorcontrib><creatorcontrib>Ramirez, Pedro T.</creatorcontrib><creatorcontrib>Iniesta-Donate, Maria</creatorcontrib><creatorcontrib>Lasala, Javier D.</creatorcontrib><creatorcontrib>Wang, Xin Shelley</creatorcontrib><creatorcontrib>Williams, Loretta A.</creatorcontrib><creatorcontrib>Meyer, Larissa</creatorcontrib><creatorcontrib>Mena, Gabriel E.</creatorcontrib><title>Opioid-sparing anesthesia and patient-reported outcomes after open gynecologic surgery: a historical cohort study</title><title>Canadian journal of anesthesia</title><addtitle>Can J Anesth/J Can Anesth</addtitle><addtitle>Can J Anaesth</addtitle><description>Purpose
Dexmedetomidine and ketamine may be administered intraoperatively as continuous infusions to provide opioid-sparing anesthesia. Recent evidence has yielded controversial results regarding the impact of opioid-free anesthesia on postoperative complications, and there is a gap in knowledge regarding patient-reported outcomes (PROs). This study aimed to determine the impact of opioid-sparing anesthesia and opioid-based anesthesia on PROs among gynecologic patients within an enhanced recovery after surgery (ERAS) program.
Methods
We formed a single-center historical cohort from patients enrolled in another study who underwent open gynecologic surgery on an ERAS program from November 2014 to December 2020 (
n
= 2,095). We identified two cohorts based on the type of balanced anesthesia administered: 1) opioid-sparing anesthesia defined as the continuous infusion of dexmedetomidine and ketamine (adjuvants) during surgery or 2) opioid-based anesthesia (no adjuvants). We measured the quality of postoperative recovery using the MD Anderson Symptom Inventory (MDASI), a 29-item validated tool that was administered preoperatively, daily while admitted, and weekly after discharge until week 6. The primary outcome was interference with walking. We matched both cohorts and used a multilevel linear mixed-effect model to evaluate the effect of opioid-sparing anesthesia on the primary outcome.
Results
In total, 498 patients were eligible (159 in the opioid-sparing anesthesia cohort and 339 in the opioid-based anesthesia cohort), of whom 149 matched pairs were included in the final analysis. Longitudinal assessment showed no significant or clinically important difference in interference with walking (
P
= 0.99), general activity (
P
= 0.99), or other PROs between cohorts. Median [interquartile range (IQR)] intraoperative opioid administration (expressed as morphine milligram equivalents [MME]) among matched patients in the opioid-sparing anesthesia cohort was 30 [25–55] mg
vs
58 [8–70] mg in the opioid-based anesthesia cohort (
P
< 0.01). Patients in the opioid-sparing anesthesia cohort had a lower opioid consumption in the postanesthesia care unit than those in the opioid-based anesthesia cohort (MME, 3 [0–10] mg
vs
5 [0–15] mg;
P
< 0.01), but there was no significant difference between cohorts in total postoperative opioid consumption (MME, 23 [0–94] mg
vs
35 [13–95] mg
P
= 0.053).
Conclusions
In this single-center historical cohort study, opioid-sparing anesthesia had no significant or clinically important effects on interference with walking or other PROs in patients undergoing gynecologic surgery compared with opioid-based anesthesia. Opioid-sparing anesthesia was associated with less short-term opioid consumption than opioid-based anesthesia.</description><subject>Analgesics, Opioid</subject><subject>Anesthesia - adverse effects</subject><subject>Anesthesiology</subject><subject>Cardiology</subject><subject>Clinical outcomes</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Critical Care Medicine</subject><subject>Dexmedetomidine</subject><subject>Female</subject><subject>Gynecologic Surgical Procedures - methods</subject><subject>Gynecological surgery</subject><subject>Humans</subject><subject>Intensive</subject><subject>Ketamine</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Morphine</subject><subject>Narcotics</subject><subject>Pain Medicine</subject><subject>Pain, Postoperative - diagnosis</subject><subject>Pain, Postoperative - drug therapy</subject><subject>Patient Reported Outcome Measures</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Pneumology/Respiratory System</subject><subject>Recovery (Medical)</subject><subject>Reports of Original Investigations</subject><issn>0832-610X</issn><issn>1496-8975</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNp9kU1r3DAQhkVoSDab_IEeiqCXXJyMPmxLvZXQfEBgLwn0JrTyeFfBazmSfNh_X6WbtNBDEUJzeN6RRg8hnxlcMYD2OjHeCKiA87KFaCp1RBZM6lLotv5EFqAErxoGP0_JWUovAKCaWp2QU9FwLmtoFuR1NfnguypNNvpxQ-2IKW8xeVvKjk42exxzFXEKMWNHw5xd2GGits8YaZhwpJv9iC4MYeMdTXPcYNx_o5ZufcohemcH6sK2xGnKc7c_J8e9HRJevJ9L8nz74-nmvnpc3T3cfH-snGQ6V13TdowjMgYSaugtWtcrBKaxdbLWGpwFrZ3opOy1rctSvVu3jYJ-rRyKJbk89J1ieJ3LVGbnk8NhKCOGORneli9Qkitd0K__oC9hjmN5XaFEy5VUtSwUP1AuhpQi9maKfmfj3jAwb0LMQYgpQsxvIUaV0Jf31vN6h92fyIeBAogDkKY3ARj_3v2ftr8A37-Yiw</recordid><startdate>20221201</startdate><enddate>20221201</enddate><creator>Zorrilla-Vaca, Andres</creator><creator>Ramirez, Pedro T.</creator><creator>Iniesta-Donate, Maria</creator><creator>Lasala, Javier D.</creator><creator>Wang, Xin Shelley</creator><creator>Williams, Loretta A.</creator><creator>Meyer, Larissa</creator><creator>Mena, Gabriel E.</creator><general>Springer International Publishing</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>8FQ</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</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>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-8140-8486</orcidid></search><sort><creationdate>20221201</creationdate><title>Opioid-sparing anesthesia and patient-reported outcomes after open gynecologic surgery: a historical cohort study</title><author>Zorrilla-Vaca, Andres ; Ramirez, Pedro T. ; Iniesta-Donate, Maria ; Lasala, Javier D. ; Wang, Xin Shelley ; Williams, Loretta A. ; Meyer, Larissa ; Mena, Gabriel E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c419t-d67d12ee1104050faeacf8e019e7c45990ca099c3d44f9a5a5a8fcb7680fb8ce3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Analgesics, Opioid</topic><topic>Anesthesia - adverse effects</topic><topic>Anesthesiology</topic><topic>Cardiology</topic><topic>Clinical outcomes</topic><topic>Cohort analysis</topic><topic>Cohort Studies</topic><topic>Critical Care Medicine</topic><topic>Dexmedetomidine</topic><topic>Female</topic><topic>Gynecologic Surgical Procedures - methods</topic><topic>Gynecological surgery</topic><topic>Humans</topic><topic>Intensive</topic><topic>Ketamine</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Morphine</topic><topic>Narcotics</topic><topic>Pain Medicine</topic><topic>Pain, Postoperative - diagnosis</topic><topic>Pain, Postoperative - drug therapy</topic><topic>Patient Reported Outcome Measures</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>Pneumology/Respiratory System</topic><topic>Recovery (Medical)</topic><topic>Reports of Original Investigations</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zorrilla-Vaca, Andres</creatorcontrib><creatorcontrib>Ramirez, Pedro T.</creatorcontrib><creatorcontrib>Iniesta-Donate, Maria</creatorcontrib><creatorcontrib>Lasala, Javier D.</creatorcontrib><creatorcontrib>Wang, Xin Shelley</creatorcontrib><creatorcontrib>Williams, Loretta A.</creatorcontrib><creatorcontrib>Meyer, Larissa</creatorcontrib><creatorcontrib>Mena, Gabriel E.</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>Canadian Business & Current Affairs Database</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</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>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Canadian journal of anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zorrilla-Vaca, Andres</au><au>Ramirez, Pedro T.</au><au>Iniesta-Donate, Maria</au><au>Lasala, Javier D.</au><au>Wang, Xin Shelley</au><au>Williams, Loretta A.</au><au>Meyer, Larissa</au><au>Mena, Gabriel E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Opioid-sparing anesthesia and patient-reported outcomes after open gynecologic surgery: a historical cohort study</atitle><jtitle>Canadian journal of anesthesia</jtitle><stitle>Can J Anesth/J Can Anesth</stitle><addtitle>Can J Anaesth</addtitle><date>2022-12-01</date><risdate>2022</risdate><volume>69</volume><issue>12</issue><spage>1477</spage><epage>1492</epage><pages>1477-1492</pages><issn>0832-610X</issn><eissn>1496-8975</eissn><abstract>Purpose
Dexmedetomidine and ketamine may be administered intraoperatively as continuous infusions to provide opioid-sparing anesthesia. Recent evidence has yielded controversial results regarding the impact of opioid-free anesthesia on postoperative complications, and there is a gap in knowledge regarding patient-reported outcomes (PROs). This study aimed to determine the impact of opioid-sparing anesthesia and opioid-based anesthesia on PROs among gynecologic patients within an enhanced recovery after surgery (ERAS) program.
Methods
We formed a single-center historical cohort from patients enrolled in another study who underwent open gynecologic surgery on an ERAS program from November 2014 to December 2020 (
n
= 2,095). We identified two cohorts based on the type of balanced anesthesia administered: 1) opioid-sparing anesthesia defined as the continuous infusion of dexmedetomidine and ketamine (adjuvants) during surgery or 2) opioid-based anesthesia (no adjuvants). We measured the quality of postoperative recovery using the MD Anderson Symptom Inventory (MDASI), a 29-item validated tool that was administered preoperatively, daily while admitted, and weekly after discharge until week 6. The primary outcome was interference with walking. We matched both cohorts and used a multilevel linear mixed-effect model to evaluate the effect of opioid-sparing anesthesia on the primary outcome.
Results
In total, 498 patients were eligible (159 in the opioid-sparing anesthesia cohort and 339 in the opioid-based anesthesia cohort), of whom 149 matched pairs were included in the final analysis. Longitudinal assessment showed no significant or clinically important difference in interference with walking (
P
= 0.99), general activity (
P
= 0.99), or other PROs between cohorts. Median [interquartile range (IQR)] intraoperative opioid administration (expressed as morphine milligram equivalents [MME]) among matched patients in the opioid-sparing anesthesia cohort was 30 [25–55] mg
vs
58 [8–70] mg in the opioid-based anesthesia cohort (
P
< 0.01). Patients in the opioid-sparing anesthesia cohort had a lower opioid consumption in the postanesthesia care unit than those in the opioid-based anesthesia cohort (MME, 3 [0–10] mg
vs
5 [0–15] mg;
P
< 0.01), but there was no significant difference between cohorts in total postoperative opioid consumption (MME, 23 [0–94] mg
vs
35 [13–95] mg
P
= 0.053).
Conclusions
In this single-center historical cohort study, opioid-sparing anesthesia had no significant or clinically important effects on interference with walking or other PROs in patients undergoing gynecologic surgery compared with opioid-based anesthesia. Opioid-sparing anesthesia was associated with less short-term opioid consumption than opioid-based anesthesia.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>36224506</pmid><doi>10.1007/s12630-022-02336-8</doi><tpages>16</tpages><orcidid>https://orcid.org/0000-0001-8140-8486</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0832-610X |
| ispartof | Canadian journal of anesthesia, 2022-12, Vol.69 (12), p.1477-1492 |
| issn | 0832-610X 1496-8975 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2724584289 |
| source | MEDLINE; SpringerLink Journals |
| subjects | Analgesics, Opioid Anesthesia - adverse effects Anesthesiology Cardiology Clinical outcomes Cohort analysis Cohort Studies Critical Care Medicine Dexmedetomidine Female Gynecologic Surgical Procedures - methods Gynecological surgery Humans Intensive Ketamine Medicine Medicine & Public Health Morphine Narcotics Pain Medicine Pain, Postoperative - diagnosis Pain, Postoperative - drug therapy Patient Reported Outcome Measures Patients Pediatrics Pneumology/Respiratory System Recovery (Medical) Reports of Original Investigations |
| title | Opioid-sparing anesthesia and patient-reported outcomes after open gynecologic surgery: a historical cohort study |
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