Multimodal opioid‐sparing pain management after lung transplantation and the impact of liposomal bupivacaine intercostal nerve block. Issue 1 (28th October 2021)

• Record Type: Journal Article
• Authors: Lewis, Tyler C.; Sureau, Kimberly; Katz, Alyson; Fargnoli, Anthony; Lesko, Melissa; Rudym, Darya; Angel, Luis F.; Chang, Stephanie H.; Kon, Zachary N.
• Is Part Of: Clinical transplantation. Volume 36:Issue 1(2022)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2021-10-28
• Subjects: enhanced recovery -- lung transplant -- opioid‐sparing -- pain -- thoracotomy; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ctr.14512
• Languages: English
• ISSNs: 0902-0063

Abstract

Abstract: Opioid analgesics are commonly used post‐lung transplant, but have many side effects and are associated with worse outcomes. We conducted a retrospective review of all lung transplant recipients who were treated with a multimodal opioid‐sparing pain protocol. The use of liposomal bupivacaine intercostal nerve block was variable due to hospital restrictions. The primary objective was to describe opioid requirements and patient‐reported pain scores early post‐lung transplant and to assess the impact of intraoperative liposomal bupivacaine intercostal nerve block. We treated 64 lung transplant recipients with our protocol. Opioid utilization decreased to a mean of 43 milligram oral morphine equivalents by postoperative day 4. Median pain scores peaked at 4 on postoperative day 1 and decreased thereafter. Only three patients were discharged home with opioids, all of whom were taking opioid agonist therapy pre‐transplant for opioid use disorder. Patients who received liposomal bupivacaine intercostal nerve block in the operating room had a significant reduction in opioid consumption over postoperative day 1 through 4 (228 mg vs. 517 mg, P = .032). A multimodal opioid‐sparing pain management protocol is feasible and resulted in weaning of opioids prior to hospital discharge.