Robot-assisted laparoscopic nephrectomy: early outcome measures with the implementation of multimodal analgesia and intrathecal morphine via the acute pain service

Purpose The objective of this study was to perform a retrospective cohort analysis, in which we measured the association of an acute pain service (APS)-driven multimodal analgesia protocol that included preoperative intrathecal morphine (ITM) compared to historic controls (i.e., surgeon-driven analg...

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Veröffentlicht in:World journal of urology 2024-03, Vol.42 (1), p.117, Article 117
Hauptverfasser: Meineke, Minhthy N., Losli, Matthew V., Sztain, Jacklynn F., Swisher, Matthew W., Abramson, Wendy B., Martin, Erin I., Furnish, Timothy J., Salmasi, Amirali, Derweesh, Ithaar H., Gabriel, Rodney A., Said, Engy T.
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Sprache:eng
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Zusammenfassung:Purpose The objective of this study was to perform a retrospective cohort analysis, in which we measured the association of an acute pain service (APS)-driven multimodal analgesia protocol that included preoperative intrathecal morphine (ITM) compared to historic controls (i.e., surgeon-driven analgesia protocol without ITM) with postoperative opioid use. Methods This was a retrospective cohort study in which the primary objective was to determine whether there was a decrease in median 24-h opioid consumption (intravenous morphine equivalents [MEQ]) among robotic nephrectomy patients whose pain was managed by the surgical team prior to the APS, versus pain managed by APS. Secondary outcomes included opioid consumption during the 24–48 h and 48–72 h period and hospital length of stay. To create matched cohorts, we performed 1:1 (APS:non-APS) propensity score matching. Due to the cohorts occurring at the different time periods, we performed a segmented regression analysis of an interrupted time series. Results There were 76 patients in the propensity-matched cohorts, in which 38 (50.0%) were in the APS cohort. The median difference in 24-h opioid consumption in the pre-APS versus APS cohort was 23.0 mg [95% CI 15.0, 31.0] ( p  
ISSN:1433-8726
0724-4983
1433-8726
DOI:10.1007/s00345-024-04801-z