Opioid Sparing Anesthesia and Enhanced Recovery After Surgery Protocol for Pancreaticoduodenectomy
Background Opioid sparing anesthesia and enhanced recovery after surgery protocols are not innovative ideas. However, the utilization of pancreaticoduodenectomy is limited. With the rise in awareness of the opioid epidemic in the United States, we have created a multimodal approach to anesthesia and...
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| Veröffentlicht in: | Curēus (Palo Alto, CA) CA), 2021-11, Vol.13 (11), p.e19558-e19558 |
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| creator | Leech, Joseph Oswalt, Kenneth Tucci, Michelle A Alam Mendez, Oscar A Hierlmeier, Bryan J |
| description | Background Opioid sparing anesthesia and enhanced recovery after surgery protocols are not innovative ideas. However, the utilization of pancreaticoduodenectomy is limited. With the rise in awareness of the opioid epidemic in the United States, we have created a multimodal approach to anesthesia and postoperative care to limit adverse effects of opioids and curb the use of opioids postoperatively. Methods We conducted a retrospective cohort study performed by chart review of an opioid-sparing anesthetic and enhanced recovery after surgery (ERAS) protocol initiated jointly by the anesthesiology departments and transplant surgery for pancreaticoduodenectomy from January 2017 to October 2019. Results Demographic data was found to be comparable between the control and protocol groups. Hospital length of stay, ICU length of stay, and opioid requirements significantly decreased in the protocol group. Hospital length of stay decreased from 8.92 to 5.72 days, ICU days decreased from 1.52 to 0.42 days, and narcotics for the first five hospital days were significantly decreased from 130.13 to 71.2 morphine milligram equivalents. Conclusion Proper postoperative pain management can improve patient satisfaction and decrease complication rates. Pancreaticoduodenectomy is a complicated procedure with relatively limited data regarding enhanced recovery after surgery protocols. Likewise, there is limited data regarding opioid-sparing anesthesia techniques. Our protocol produced promising hospital length of stay and reduced opioid administration during the first five hospital days without increasing 30-day readmission rates. |
| doi_str_mv | 10.7759/cureus.19558 |
| format | Article |
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However, the utilization of pancreaticoduodenectomy is limited. With the rise in awareness of the opioid epidemic in the United States, we have created a multimodal approach to anesthesia and postoperative care to limit adverse effects of opioids and curb the use of opioids postoperatively. Methods We conducted a retrospective cohort study performed by chart review of an opioid-sparing anesthetic and enhanced recovery after surgery (ERAS) protocol initiated jointly by the anesthesiology departments and transplant surgery for pancreaticoduodenectomy from January 2017 to October 2019. Results Demographic data was found to be comparable between the control and protocol groups. Hospital length of stay, ICU length of stay, and opioid requirements significantly decreased in the protocol group. Hospital length of stay decreased from 8.92 to 5.72 days, ICU days decreased from 1.52 to 0.42 days, and narcotics for the first five hospital days were significantly decreased from 130.13 to 71.2 morphine milligram equivalents. Conclusion Proper postoperative pain management can improve patient satisfaction and decrease complication rates. Pancreaticoduodenectomy is a complicated procedure with relatively limited data regarding enhanced recovery after surgery protocols. Likewise, there is limited data regarding opioid-sparing anesthesia techniques. Our protocol produced promising hospital length of stay and reduced opioid administration during the first five hospital days without increasing 30-day readmission rates.</description><identifier>ISSN: 2168-8184</identifier><identifier>EISSN: 2168-8184</identifier><identifier>DOI: 10.7759/cureus.19558</identifier><identifier>PMID: 34917438</identifier><language>eng</language><publisher>United States: Cureus Inc</publisher><subject>Age ; Analgesics ; Anesthesia ; Anesthesiology ; Body mass index ; Drug dosages ; General Surgery ; Hospital costs ; Length of stay ; Medical personnel ; Morbidity ; Morphine ; Mortality ; Narcotics ; Pain ; Pain Management ; Pancreaticoduodenectomy ; Patient safety ; Patient satisfaction ; Physical therapy ; Recovery (Medical) ; Surgery ; Surgical anastomosis</subject><ispartof>Curēus (Palo Alto, CA), 2021-11, Vol.13 (11), p.e19558-e19558</ispartof><rights>Copyright © 2021, Leech et al.</rights><rights>Copyright © 2021, Leech et al. This work is published under https://creativecommons.org/licenses/by/3.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright © 2021, Leech et al. 2021 Leech et al.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c304t-56e3399d8a7b4e6bc89bca399a67517f016f8f06e7bd3fa006bb568caee627ba3</citedby><cites>FETCH-LOGICAL-c304t-56e3399d8a7b4e6bc89bca399a67517f016f8f06e7bd3fa006bb568caee627ba3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8669974/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8669974/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34917438$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Leech, Joseph</creatorcontrib><creatorcontrib>Oswalt, Kenneth</creatorcontrib><creatorcontrib>Tucci, Michelle A</creatorcontrib><creatorcontrib>Alam Mendez, Oscar A</creatorcontrib><creatorcontrib>Hierlmeier, Bryan J</creatorcontrib><title>Opioid Sparing Anesthesia and Enhanced Recovery After Surgery Protocol for Pancreaticoduodenectomy</title><title>Curēus (Palo Alto, CA)</title><addtitle>Cureus</addtitle><description>Background Opioid sparing anesthesia and enhanced recovery after surgery protocols are not innovative ideas. However, the utilization of pancreaticoduodenectomy is limited. With the rise in awareness of the opioid epidemic in the United States, we have created a multimodal approach to anesthesia and postoperative care to limit adverse effects of opioids and curb the use of opioids postoperatively. Methods We conducted a retrospective cohort study performed by chart review of an opioid-sparing anesthetic and enhanced recovery after surgery (ERAS) protocol initiated jointly by the anesthesiology departments and transplant surgery for pancreaticoduodenectomy from January 2017 to October 2019. Results Demographic data was found to be comparable between the control and protocol groups. Hospital length of stay, ICU length of stay, and opioid requirements significantly decreased in the protocol group. Hospital length of stay decreased from 8.92 to 5.72 days, ICU days decreased from 1.52 to 0.42 days, and narcotics for the first five hospital days were significantly decreased from 130.13 to 71.2 morphine milligram equivalents. Conclusion Proper postoperative pain management can improve patient satisfaction and decrease complication rates. Pancreaticoduodenectomy is a complicated procedure with relatively limited data regarding enhanced recovery after surgery protocols. Likewise, there is limited data regarding opioid-sparing anesthesia techniques. Our protocol produced promising hospital length of stay and reduced opioid administration during the first five hospital days without increasing 30-day readmission rates.</description><subject>Age</subject><subject>Analgesics</subject><subject>Anesthesia</subject><subject>Anesthesiology</subject><subject>Body mass index</subject><subject>Drug dosages</subject><subject>General Surgery</subject><subject>Hospital costs</subject><subject>Length of stay</subject><subject>Medical personnel</subject><subject>Morbidity</subject><subject>Morphine</subject><subject>Mortality</subject><subject>Narcotics</subject><subject>Pain</subject><subject>Pain Management</subject><subject>Pancreaticoduodenectomy</subject><subject>Patient safety</subject><subject>Patient satisfaction</subject><subject>Physical therapy</subject><subject>Recovery (Medical)</subject><subject>Surgery</subject><subject>Surgical anastomosis</subject><issn>2168-8184</issn><issn>2168-8184</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNpdkclLAzEUxoMoVmpvniXgxYOtySxZLkIRNxAUl3NIMm_ayDSpyYzQ_96p1aKe3vbj8b73IXREyYTzUp7bLkKXJlSWpdhBBxllYiyoKHZ_5QM0SumNEEIJzwgn-2iQF5LyIhcHyDwsXXAVfl7q6PwMTz2kdg7Jaax9ha_8XHsLFX4CGz4grvC0biHi5y7O1tVjDG2wocF1iPixRyPo1tlQdaECD7YNi9Uh2qt1k2D0HYfo9frq5fJ2fP9wc3c5vR_bnBTtuGSQ51JWQnNTADNWSGN139GMl5TXhLJa1IQBN1Vea0KYMSUTVgOwjBudD9HFZu-yMwuoLPg26kYto1vouFJBO_V34t1czcKHEoxJ2b9jiE6_F8Tw3vV_UAuXLDSN9hC6pDJGKSu5ZGv05B_6Frroe3k9lWWSSSFJT51tKBtDShHq7TGUqLV_auOf-vKvx49_C9jCP27lnxkVme0</recordid><startdate>20211114</startdate><enddate>20211114</enddate><creator>Leech, Joseph</creator><creator>Oswalt, Kenneth</creator><creator>Tucci, Michelle A</creator><creator>Alam Mendez, Oscar A</creator><creator>Hierlmeier, Bryan J</creator><general>Cureus Inc</general><general>Cureus</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20211114</creationdate><title>Opioid Sparing Anesthesia and Enhanced Recovery After Surgery Protocol for Pancreaticoduodenectomy</title><author>Leech, Joseph ; Oswalt, Kenneth ; Tucci, Michelle A ; Alam Mendez, Oscar A ; Hierlmeier, Bryan J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c304t-56e3399d8a7b4e6bc89bca399a67517f016f8f06e7bd3fa006bb568caee627ba3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Age</topic><topic>Analgesics</topic><topic>Anesthesia</topic><topic>Anesthesiology</topic><topic>Body mass index</topic><topic>Drug dosages</topic><topic>General Surgery</topic><topic>Hospital costs</topic><topic>Length of stay</topic><topic>Medical personnel</topic><topic>Morbidity</topic><topic>Morphine</topic><topic>Mortality</topic><topic>Narcotics</topic><topic>Pain</topic><topic>Pain Management</topic><topic>Pancreaticoduodenectomy</topic><topic>Patient safety</topic><topic>Patient satisfaction</topic><topic>Physical therapy</topic><topic>Recovery (Medical)</topic><topic>Surgery</topic><topic>Surgical anastomosis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Leech, Joseph</creatorcontrib><creatorcontrib>Oswalt, Kenneth</creatorcontrib><creatorcontrib>Tucci, Michelle A</creatorcontrib><creatorcontrib>Alam Mendez, Oscar A</creatorcontrib><creatorcontrib>Hierlmeier, Bryan J</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Health and Medical</collection><collection>ProQuest Central (purchase pre-March 2016)</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)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</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>Health & Medical Collection (Alumni Edition)</collection><collection>ProQuest - Publicly Available Content Database</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><collection>PubMed Central (Full Participant titles)</collection><jtitle>Curēus (Palo Alto, CA)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Leech, Joseph</au><au>Oswalt, Kenneth</au><au>Tucci, Michelle A</au><au>Alam Mendez, Oscar A</au><au>Hierlmeier, Bryan J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Opioid Sparing Anesthesia and Enhanced Recovery After Surgery Protocol for Pancreaticoduodenectomy</atitle><jtitle>Curēus (Palo Alto, CA)</jtitle><addtitle>Cureus</addtitle><date>2021-11-14</date><risdate>2021</risdate><volume>13</volume><issue>11</issue><spage>e19558</spage><epage>e19558</epage><pages>e19558-e19558</pages><issn>2168-8184</issn><eissn>2168-8184</eissn><abstract>Background Opioid sparing anesthesia and enhanced recovery after surgery protocols are not innovative ideas. However, the utilization of pancreaticoduodenectomy is limited. With the rise in awareness of the opioid epidemic in the United States, we have created a multimodal approach to anesthesia and postoperative care to limit adverse effects of opioids and curb the use of opioids postoperatively. Methods We conducted a retrospective cohort study performed by chart review of an opioid-sparing anesthetic and enhanced recovery after surgery (ERAS) protocol initiated jointly by the anesthesiology departments and transplant surgery for pancreaticoduodenectomy from January 2017 to October 2019. Results Demographic data was found to be comparable between the control and protocol groups. Hospital length of stay, ICU length of stay, and opioid requirements significantly decreased in the protocol group. Hospital length of stay decreased from 8.92 to 5.72 days, ICU days decreased from 1.52 to 0.42 days, and narcotics for the first five hospital days were significantly decreased from 130.13 to 71.2 morphine milligram equivalents. Conclusion Proper postoperative pain management can improve patient satisfaction and decrease complication rates. Pancreaticoduodenectomy is a complicated procedure with relatively limited data regarding enhanced recovery after surgery protocols. Likewise, there is limited data regarding opioid-sparing anesthesia techniques. Our protocol produced promising hospital length of stay and reduced opioid administration during the first five hospital days without increasing 30-day readmission rates.</abstract><cop>United States</cop><pub>Cureus Inc</pub><pmid>34917438</pmid><doi>10.7759/cureus.19558</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Age Analgesics Anesthesia Anesthesiology Body mass index Drug dosages General Surgery Hospital costs Length of stay Medical personnel Morbidity Morphine Mortality Narcotics Pain Pain Management Pancreaticoduodenectomy Patient safety Patient satisfaction Physical therapy Recovery (Medical) Surgery Surgical anastomosis |
| title | Opioid Sparing Anesthesia and Enhanced Recovery After Surgery Protocol for Pancreaticoduodenectomy |
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