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...
Gespeichert in:
| Veröffentlicht in: | World journal of urology 2024-03, Vol.42 (1), p.117, Article 117 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | |
|---|---|
| container_issue | 1 |
| container_start_page | 117 |
| container_title | World journal of urology |
| container_volume | 42 |
| creator | 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. |
| description | 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
|
| doi_str_mv | 10.1007/s00345-024-04801-z |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10912429</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2937338715</sourcerecordid><originalsourceid>FETCH-LOGICAL-c426t-ed5fd17982d6fbf001f91209094a5ba4f6d1ee8043b3ee85f1383d9bbf3ef1cf3</originalsourceid><addsrcrecordid>eNp9ksuKFTEQhhtRnHH0BVxIwI2b1tz65kaGwRsMCKLrkE5XTmfIpU3SR868ji9qjj2OowtXVVBf_alK_VX1lOCXBOPuVcKY8abGlNeY95jU1_eqU8IZq_uOtvfv5CfVo5SuMCZdi5uH1QnrOWt72p9WPz6HMeRapmRShglZucgYkgqLUcjDMkdQObjDawQy2gMKa1bBAXIg0xohoe8mzyjPgIxbLDjwWWYTPAoaudVm48IkLZJe2h0kI0s2IeNzlKVHlYoLcZmNB7QvxaOOVGsGtEjjUYK4NwoeVw-0tAme3MSz6uu7t18uPtSXn95_vDi_rBWnba5havREuqGnU6tHXbbVA6F4wAOXzSi5bicC0GPORlZiownr2TSMo2agidLsrHqz6S7r6GBScBzTiiUaJ-NBBGnE3xVvZrELe0FweYjToSi8uFGI4dsKKQtnkgJrpYewJlGQjrG-I01Bn_-DXoU1lm_aKNL0lLaFohulylFSBH07DcHiaAKxmUAUE4hfJhDXpenZ3T1uW35fvQBsA1Ip-R3EP2__R_YnZt7D1g</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2937158226</pqid></control><display><type>article</type><title>Robot-assisted laparoscopic nephrectomy: early outcome measures with the implementation of multimodal analgesia and intrathecal morphine via the acute pain service</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>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.</creator><creatorcontrib>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.</creatorcontrib><description>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
< 0.0001), in favor of APS. There were no differences in the secondary outcomes. On segmented regression, there was a statistically significant drop in 24-h opioid consumption in the APS cohort versus pre-APS cohort (
p
= 0.005).
Conclusions
The implementation of an APS-driven multimodal analgesia protocol with ITM demonstrated a beneficial association with postoperative 24-h opioid consumption following robot-assisted nephrectomy.</description><identifier>ISSN: 1433-8726</identifier><identifier>ISSN: 0724-4983</identifier><identifier>EISSN: 1433-8726</identifier><identifier>DOI: 10.1007/s00345-024-04801-z</identifier><identifier>PMID: 38436828</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Analgesia ; Analgesics, Opioid - therapeutic use ; Humans ; Laparoscopy ; Medicine ; Medicine & Public Health ; Morphine ; Morphine - therapeutic use ; Narcotics ; Nephrectomy ; Nephrology ; Oncology ; Opioids ; Original ; Original Article ; Pain ; Pain Clinics ; Pain perception ; Retrospective Studies ; Robotic surgery ; Robotics ; Statistical analysis ; Urology</subject><ispartof>World journal of urology, 2024-03, Vol.42 (1), p.117, Article 117</ispartof><rights>The Author(s) 2024</rights><rights>2024. The Author(s).</rights><rights>Copyright Springer Nature B.V. Dec 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c426t-ed5fd17982d6fbf001f91209094a5ba4f6d1ee8043b3ee85f1383d9bbf3ef1cf3</cites><orcidid>0000-0003-4443-0021</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/s00345-024-04801-z$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00345-024-04801-z$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38436828$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Meineke, Minhthy N.</creatorcontrib><creatorcontrib>Losli, Matthew V.</creatorcontrib><creatorcontrib>Sztain, Jacklynn F.</creatorcontrib><creatorcontrib>Swisher, Matthew W.</creatorcontrib><creatorcontrib>Abramson, Wendy B.</creatorcontrib><creatorcontrib>Martin, Erin I.</creatorcontrib><creatorcontrib>Furnish, Timothy J.</creatorcontrib><creatorcontrib>Salmasi, Amirali</creatorcontrib><creatorcontrib>Derweesh, Ithaar H.</creatorcontrib><creatorcontrib>Gabriel, Rodney A.</creatorcontrib><creatorcontrib>Said, Engy T.</creatorcontrib><title>Robot-assisted laparoscopic nephrectomy: early outcome measures with the implementation of multimodal analgesia and intrathecal morphine via the acute pain service</title><title>World journal of urology</title><addtitle>World J Urol</addtitle><addtitle>World J Urol</addtitle><description>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
< 0.0001), in favor of APS. There were no differences in the secondary outcomes. On segmented regression, there was a statistically significant drop in 24-h opioid consumption in the APS cohort versus pre-APS cohort (
p
= 0.005).
Conclusions
The implementation of an APS-driven multimodal analgesia protocol with ITM demonstrated a beneficial association with postoperative 24-h opioid consumption following robot-assisted nephrectomy.</description><subject>Analgesia</subject><subject>Analgesics, Opioid - therapeutic use</subject><subject>Humans</subject><subject>Laparoscopy</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Morphine</subject><subject>Morphine - therapeutic use</subject><subject>Narcotics</subject><subject>Nephrectomy</subject><subject>Nephrology</subject><subject>Oncology</subject><subject>Opioids</subject><subject>Original</subject><subject>Original Article</subject><subject>Pain</subject><subject>Pain Clinics</subject><subject>Pain perception</subject><subject>Retrospective Studies</subject><subject>Robotic surgery</subject><subject>Robotics</subject><subject>Statistical analysis</subject><subject>Urology</subject><issn>1433-8726</issn><issn>0724-4983</issn><issn>1433-8726</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><recordid>eNp9ksuKFTEQhhtRnHH0BVxIwI2b1tz65kaGwRsMCKLrkE5XTmfIpU3SR868ji9qjj2OowtXVVBf_alK_VX1lOCXBOPuVcKY8abGlNeY95jU1_eqU8IZq_uOtvfv5CfVo5SuMCZdi5uH1QnrOWt72p9WPz6HMeRapmRShglZucgYkgqLUcjDMkdQObjDawQy2gMKa1bBAXIg0xohoe8mzyjPgIxbLDjwWWYTPAoaudVm48IkLZJe2h0kI0s2IeNzlKVHlYoLcZmNB7QvxaOOVGsGtEjjUYK4NwoeVw-0tAme3MSz6uu7t18uPtSXn95_vDi_rBWnba5havREuqGnU6tHXbbVA6F4wAOXzSi5bicC0GPORlZiownr2TSMo2agidLsrHqz6S7r6GBScBzTiiUaJ-NBBGnE3xVvZrELe0FweYjToSi8uFGI4dsKKQtnkgJrpYewJlGQjrG-I01Bn_-DXoU1lm_aKNL0lLaFohulylFSBH07DcHiaAKxmUAUE4hfJhDXpenZ3T1uW35fvQBsA1Ip-R3EP2__R_YnZt7D1g</recordid><startdate>20240304</startdate><enddate>20240304</enddate><creator>Meineke, Minhthy N.</creator><creator>Losli, Matthew V.</creator><creator>Sztain, Jacklynn F.</creator><creator>Swisher, Matthew W.</creator><creator>Abramson, Wendy B.</creator><creator>Martin, Erin I.</creator><creator>Furnish, Timothy J.</creator><creator>Salmasi, Amirali</creator><creator>Derweesh, Ithaar H.</creator><creator>Gabriel, Rodney A.</creator><creator>Said, Engy T.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>C6C</scope><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>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-4443-0021</orcidid></search><sort><creationdate>20240304</creationdate><title>Robot-assisted laparoscopic nephrectomy: early outcome measures with the implementation of multimodal analgesia and intrathecal morphine via the acute pain service</title><author>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.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c426t-ed5fd17982d6fbf001f91209094a5ba4f6d1ee8043b3ee85f1383d9bbf3ef1cf3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Analgesia</topic><topic>Analgesics, Opioid - therapeutic use</topic><topic>Humans</topic><topic>Laparoscopy</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Morphine</topic><topic>Morphine - therapeutic use</topic><topic>Narcotics</topic><topic>Nephrectomy</topic><topic>Nephrology</topic><topic>Oncology</topic><topic>Opioids</topic><topic>Original</topic><topic>Original Article</topic><topic>Pain</topic><topic>Pain Clinics</topic><topic>Pain perception</topic><topic>Retrospective Studies</topic><topic>Robotic surgery</topic><topic>Robotics</topic><topic>Statistical analysis</topic><topic>Urology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Meineke, Minhthy N.</creatorcontrib><creatorcontrib>Losli, Matthew V.</creatorcontrib><creatorcontrib>Sztain, Jacklynn F.</creatorcontrib><creatorcontrib>Swisher, Matthew W.</creatorcontrib><creatorcontrib>Abramson, Wendy B.</creatorcontrib><creatorcontrib>Martin, Erin I.</creatorcontrib><creatorcontrib>Furnish, Timothy J.</creatorcontrib><creatorcontrib>Salmasi, Amirali</creatorcontrib><creatorcontrib>Derweesh, Ithaar H.</creatorcontrib><creatorcontrib>Gabriel, Rodney A.</creatorcontrib><creatorcontrib>Said, Engy T.</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>World journal of urology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Meineke, Minhthy N.</au><au>Losli, Matthew V.</au><au>Sztain, Jacklynn F.</au><au>Swisher, Matthew W.</au><au>Abramson, Wendy B.</au><au>Martin, Erin I.</au><au>Furnish, Timothy J.</au><au>Salmasi, Amirali</au><au>Derweesh, Ithaar H.</au><au>Gabriel, Rodney A.</au><au>Said, Engy T.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Robot-assisted laparoscopic nephrectomy: early outcome measures with the implementation of multimodal analgesia and intrathecal morphine via the acute pain service</atitle><jtitle>World journal of urology</jtitle><stitle>World J Urol</stitle><addtitle>World J Urol</addtitle><date>2024-03-04</date><risdate>2024</risdate><volume>42</volume><issue>1</issue><spage>117</spage><pages>117-</pages><artnum>117</artnum><issn>1433-8726</issn><issn>0724-4983</issn><eissn>1433-8726</eissn><abstract>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
< 0.0001), in favor of APS. There were no differences in the secondary outcomes. On segmented regression, there was a statistically significant drop in 24-h opioid consumption in the APS cohort versus pre-APS cohort (
p
= 0.005).
Conclusions
The implementation of an APS-driven multimodal analgesia protocol with ITM demonstrated a beneficial association with postoperative 24-h opioid consumption following robot-assisted nephrectomy.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>38436828</pmid><doi>10.1007/s00345-024-04801-z</doi><orcidid>https://orcid.org/0000-0003-4443-0021</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1433-8726 |
| ispartof | World journal of urology, 2024-03, Vol.42 (1), p.117, Article 117 |
| issn | 1433-8726 0724-4983 1433-8726 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10912429 |
| source | MEDLINE; SpringerLink Journals |
| subjects | Analgesia Analgesics, Opioid - therapeutic use Humans Laparoscopy Medicine Medicine & Public Health Morphine Morphine - therapeutic use Narcotics Nephrectomy Nephrology Oncology Opioids Original Original Article Pain Pain Clinics Pain perception Retrospective Studies Robotic surgery Robotics Statistical analysis Urology |
| title | Robot-assisted laparoscopic nephrectomy: early outcome measures with the implementation of multimodal analgesia and intrathecal morphine via the acute pain service |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-15T22%3A36%3A39IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Robot-assisted%20laparoscopic%20nephrectomy:%20early%20outcome%20measures%20with%20the%20implementation%20of%20multimodal%20analgesia%20and%20intrathecal%20morphine%20via%20the%20acute%20pain%20service&rft.jtitle=World%20journal%20of%20urology&rft.au=Meineke,%20Minhthy%20N.&rft.date=2024-03-04&rft.volume=42&rft.issue=1&rft.spage=117&rft.pages=117-&rft.artnum=117&rft.issn=1433-8726&rft.eissn=1433-8726&rft_id=info:doi/10.1007/s00345-024-04801-z&rft_dat=%3Cproquest_pubme%3E2937338715%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2937158226&rft_id=info:pmid/38436828&rfr_iscdi=true |