Implementation of a peri‐operative pain‐management algorithm reduces the use of opioid analgesia following pelvic exenteration surgery. (28th December 2022)

• Record Type: Journal Article
• Authors: Johnstone, Charlotte S.; Koh, Cherry E.; Britton, Gregory J.; Solomon, Michael J.; McLachlan, Andrew J.
• Is Part Of: Colorectal disease. Volume 25:Number 4(2023)
• Page Start: 631
• Page End: 639
• Publication Date: 2022-12-28
• Subjects: cancer -- pain -- pelvic exenteration -- pelvic resection; Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; 616.34
• DOI: 10.1111/codi.16442
• Languages: English
• ISSNs: 1462-8910

Abstract

Abstract: Aim: This study aimed to investigate the implementation and pain‐related outcomes of a peri‐operative pain‐management regimen for patients undergoing pelvic exenteration surgery at a university teaching hospital. Method: This is a single‐site prospective observational cohort study involving 100 patients who underwent pelvic exenteration surgery between January 2017 and December 2018. A pain‐management algorithm regarding the use of opioid‐sparing multimodal analgesia was developed between the departments of anaesthesia, pain management and intensive care. The primary outcomes were: compliance with a pain‐treatment algorithm compared with a similar retrospective surgical patient cohort in 2013–2014; and requirements for regular doses of opioid analgesia at discharge, measured in oral morphine equivalent daily dose (oMEDD). Results: Following the introduction of a pain‐management algorithm, regional anaesthesia techniques (spinal anaesthesia, transversus abdominus plane block, preperitoneal catheters or epidural analgesia) were used in 83/98 (84.7%) of the 2017–2018 cohort compared with 13/73 (17.8%) of the 2013–2014 cohort ( p < 0.001). There was a reduction in the median dose of opioid analgesics (oMEDD) at time of discharge, from 150 mg (interquartile range [IQR]: 75.0–235.0 mg) in the 2013–2014 cohort to 10 mg (IQR: 0.00–45.0 mg) in the 2017–2018 cohort ( p < 0.001). There was no change in pain intensity (assessed using the Verbal Numerical Rating Score) or oMEDD in the first 7 days following surgery. Conclusion: Since implementation of a novel peri‐operative pain‐treatment algorithm, the use of opioid‐sparing regional techniques and preperitoneal catheters has increased. Additionally, the dose of opioids required at the time of discharge has reduced significantly.