Opioid-Free Versus Opioid-Based Anesthesia in Pancreatic Surgery

Abstract Background: Opioid-free anesthesia (OFA) is associated with significantly reduced cumulative postoperative morphine consumption and postoperative nausea and vomiting in comparison with opioid-based anesthesia (OBA). Whether OFA is feasible and may improve outcomes in pancreatic surgery remains unclear. Hence, we retrospectively reviewed a consecutive cohort of patients undergoing pancreatic surgery. Methods: Perioperative data from 77 consecutive patients who underwent pancreatic resection under OBA or OFA were included. Patients received either an OBA with intraoperative remifentanil (n=42) or an OFA (n=35) with a combination of continuous infusions of dexmedetomidine, lidocaine, and esketamine. In OBA, patients also received a single bolus of intrathecal morphine. All patients received intraoperative propofol, sevoflurane, dexamethasone, diclofenac, neuromuscular blockade, postoperative continuous wound infiltration, and patient-controlled morphine. The primary outcome was postoperative pain (Numerical Rating Scale, NRS). Opioid consumption within 48h after extubation, length of stay (LOS), adverse events within 90 days, and 30-day mortality were included as secondary outcomes. Episodes of bradycardia and hypotension requiring rescue medication were considered as safety outcomes.Results: Compared to OBA, NRS (3 [2-4] vs 0 [0-2], P<0.001) and opioid consumption (36 [24-52] vs 10 [2-24], P=0.005) were both less in the OFA group. LOS was shorter by 4 days with OFA (14 [7-46] vs 10 [6-16], P<0.001). OFA (P=0.03), postoperative pancreatic fistula (P=0.0002) and delayed gastric emptying (P<0.0001) were identified as only independent factors for LOS. The comprehensive complication index (CCI) was the lowest with OFA (24.9±25.5 vs 14.1±23.4, P=0.03). There were no differences in demographics, operative time, blood loss, bradycardia, vasopressors administration or time to extubation among groups.Conclusions: In this series, OFA during pancreatic resection is feasible and independently associated with a better outcome, in particular pain outcomes. The lower rate of postoperative complications may justify future randomized trials to test the hypothesis that OFA may improve outcomes and shorten length of stay.

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Opioid-free versus opioid-based anesthesia in pancreatic surgery

BMC Anesthesiology ◽

10.1186/s12871-021-01551-y ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Hublet Stéphane ◽

Galland Marianne ◽

Navez Julie ◽

Loi Patrizia ◽

Closset Jean ◽

...

Keyword(s):

Postoperative Pain ◽

Length Of Stay ◽

Pancreatic Resection ◽

Pancreatic Surgery ◽

Rating Scale ◽

Numerical Rating Scale ◽

Intrathecal Morphine ◽

Opioid Consumption ◽

Comprehensive Complication Index ◽

Wound Infiltration

Abstract Background Opioid-free anesthesia (OFA) is associated with significantly reduced cumulative postoperative morphine consumption in comparison with opioid-based anesthesia (OBA). Whether OFA is feasible and may improve outcomes in pancreatic surgery remains unclear. Methods Perioperative data from 77 consecutive patients who underwent pancreatic resection were included and retrospectively reviewed. Patients received either an OBA with intraoperative remifentanil (n = 42) or an OFA (n = 35). OFA included a combination of continuous infusions of dexmedetomidine, lidocaine, and esketamine. In OBA, patients also received a single bolus of intrathecal morphine. All patients received intraoperative propofol, sevoflurane, dexamethasone, diclofenac, neuromuscular blockade. Postoperative pain management was achieved by continuous wound infiltration and patient-controlled morphine. The primary outcome was postoperative pain (Numerical Rating Scale, NRS). Opioid consumption within 48 h after extubation, length of stay, adverse events within 90 days, and 30-day mortality were included as secondary outcomes. Episodes of bradycardia and hypotension requiring rescue medication were considered as safety outcomes. Results Compared to OBA, NRS (3 [2–4] vs 0 [0–2], P < 0.001) and opioid consumption (36 [24–52] vs 10 [2–24], P = 0.005) were both less in the OFA group. Length of stay was shorter by 4 days with OFA (14 [7–46] vs 10 [6–16], P < 0.001). OFA (P = 0.03), with postoperative pancreatic fistula (P = 0.0002) and delayed gastric emptying (P < 0.0001) were identified as only independent factors for length of stay. The comprehensive complication index (CCI) was the lowest with OFA (24.9 ± 25.5 vs 14.1 ± 23.4, P = 0.03). There were no differences in demographics, operative time, blood loss, bradycardia, vasopressors administration or time to extubation among groups. Conclusions In this series, OFA during pancreatic resection is feasible and independently associated with a better outcome, in particular pain outcomes. The lower rate of postoperative complications may justify future randomized trials to test the hypothesis that OFA may improve outcomes and shorten length of stay.

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Regional anaesthesia for postoperative pain management after liver resection

Acta medica Lituanica ◽

10.6001/actamedica.v19i3.2434 ◽

2012 ◽

Vol 19 (3) ◽

pp. 126-129

Author(s):

Darius Trepenaitis ◽

Tadas Česnaitis ◽

Andrius Macas

Keyword(s):

Pain Management ◽

Liver Resection ◽

Postoperative Pain ◽

Adverse Effects ◽

Rating Scale ◽

Numerical Rating Scale ◽

Postoperative Pain Management ◽

Control Group ◽

Wound Infiltration ◽

Adequate Treatment

Background. Pain is the most common complication in the postoperative period. If adequate treatment is not taken, it can transform to chronic pain. Postoperative pain brings a lot of social, psychological and financial problems for patients and their families. Materials and methods. This prospective study included 30 patients after laparatomic liver resection operation. Patients were randomly assign ed to Infiltrated or Control groups. An infiltration of 40 ml levobupivacaine 0.25% solution to the operation cut edges was performed to the Infiltrated group. The pain was evaluated using the numerical rating scale after 2, 5, 12, 24, 48 hours and 1 month after the operation. Our aim was to determine the effect of local anesthesia in the operation wound. The total usage of morphine and any side effects were registered. Results. A statistically significant reduction in pain was observed in the Infiltrated group in all evaluation periods. Opioids usage was higher in the Control group almost by 4 times and adverse effects were 9 to 1 compared to the Infiltrated group. Conclusions. Surgical wound infiltration with local anesthetic for postoperative pain management after liver resection operations has a positive effect on postoperative pain reduction and leads to lesser usage of opioid analgetics. As a result, there is a less chance of opioids induced adverse effects.

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Predictors of chronic neuropathic pain after scoliosis surgery in children

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2017.09.002 ◽

2017 ◽

Vol 17 (1) ◽

pp. 339-344 ◽

Cited By ~ 6

Author(s):

Florence Julien-Marsollier ◽

Raphaelle David ◽

Julie Hilly ◽

Christopher Brasher ◽

Daphné Michelet ◽

...

Keyword(s):

Chronic Pain ◽

Logistic Regression ◽

Neuropathic Pain ◽

Rating Scale ◽

Numerical Rating Scale ◽

Univariate Analysis ◽

Opioid Consumption ◽

Multivariate Logistic Regression Model ◽

Scoliosis Surgery ◽

Preoperative Pain

AbstractBackgroundNumerous publications describe chronic pain following surgery in both adults and children. However, data in the paediatric population are still sparse and both prevalence of chronic pain after surgery and risk factors of this complication still undetermined.MethodsWe prospectively evaluated the prevalence of chronic pain and its neuropathic pain component at 1 year following correction of idiopathic scoliosis in children less than 18 years of age. Pain was defined as the presence of pain (numerical rating scale – NRS ≥4), the presence of signs of neurologic damage within the area of surgery and the presence of the neuropathic symptoms as a DN4 (Douleur Neuropathique 4) questionnaire ≥4. Factors investigated as potentially associated with the presence of a persistent neuropathic pain were: age, weight, the presence of continuous preoperative pain over the 3 months before surgery, surgical characteristics, pain scores during the first five postoperative days, and DN4 at day 3. Statistical analysis employed univariate analysis and a multivariate logistic regression model.ResultsThirty six patients were included in the study. Nineteen (52.8%) had pain at one year after surgery. Among them 17 (48.2%) had neuropathic pain. Logistic regression found continuous pain over the 3 months preceding surgery and day 1 morphine consumption ≥0.5 mg kg-1 as independent predictors of persistent chronic pain with a neuropathic component. The overall model accuracy was 80.6 and the area under the curve of the model was 0.89 (95% confidence interval 0.78–0.99).ConclusionsThe present study found a high proportion of paediatric patients developing chronic persistent pain after surgical correction of scoliosis diformity. It allows identifying two factors associated with the occurrence of persistent chronic pain with a neuropathic component: the presence of persistent preoperative pain during the 3 months preceeding surgery and postoperative opioid consumption at day 1 –;0.5 mg kg-1ImplicationPatients scheduled for spine surgery and presenting with preoperative pain should be considered at risk of chronic pain after surgery and managed accordingly by the chronic and/or acute pain team. Postoperative opioid consumption should be lowered as possible by using multimodal analgesia and regional analgesia such as postoperative epidural analgesia.

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Dexamethasone Dose and Early Postoperative Recovery after Mastectomy

Anesthesiology ◽

10.1097/aln.0000000000003112 ◽

2020 ◽

Vol 132 (4) ◽

pp. 678-691

Author(s):

Kristin Julia Steinthorsdottir ◽

Hussein Nasser Awada ◽

Hanne Abildstrøm ◽

Niels Kroman ◽

Henrik Kehlet ◽

...

Keyword(s):

Length Of Stay ◽

Odds Ratio ◽

Primary Outcome ◽

Rating Scale ◽

Postoperative Recovery ◽

Postanesthesia Care Unit ◽

Early Recovery ◽

Wound Infiltration ◽

Pain Scores ◽

Number Of Patients

Abstract Background Pain and nausea are the most common challenges in postoperative recovery after mastectomy. Preventive measures include multimodal analgesia with preoperative glucocorticoid. The aim of this study was to investigate whether 24 mg of preoperative dexamethasone was superior to 8 mg on early recovery after mastectomy in addition to a simple analgesic protocol. Methods In a randomized, double-blind trial, patients 18 yr of age or older having mastectomy were randomized 1:1 to 24 mg or 8 mg dexamethasone, and all received a standardized anesthetic and surgical protocol with preoperative acetaminophen, total intravenous anesthesia, and local anesthetic wound infiltration. The primary endpoint was number of patients transferred to the postanesthesia care unit according to standardized discharge criteria (modified Aldrete score). Secondary endpoints included pain and nausea at extubation, transfer from the operating room and upon arrival at the ward, length of stay, seroma occurrence, and wound infections. Results One hundred thirty patients (65 in each group) were included and analyzed for the primary outcome. Twenty-three (35%) in each group met the primary outcome, without significant differences in standardized discharge scores (odds ratio, 1.00 [95% CI, 0.49 to 2.05], P > 0.999). More patients had seroma requiring drainage in the 24 mg versus 8 mg group, 94% versus 81%, respectively (odds ratio, 3.53 [95% CI, 1.07 to 11.6], P = 0.030). Median pain scores were low at all measured time points, numeric rating scale less than or equal to 2 versus less than or equal to 1 in the 24 mg versus 8 mg group, respectively. Six patients in each group (9%) experienced nausea at any time during hospital stay (P > 0.999). Length of stay was median 11 and 9.2 h in the 24 and 8 mg group, respectively (P = 0.217). Conclusions The authors found no evidence of 24 mg versus 8 mg of dexamethasone affecting the primary outcome regarding immediate recovery after mastectomy. The authors observed a short length of stay and low pain scores despite a simple analgesic protocol. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Fentanyl versus remifentanil-based TIVA for pediatric scoliosis repair: does it matter?

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2018-100217 ◽

2019 ◽

Vol 44 (6) ◽

pp. 627-631 ◽

Cited By ~ 4

Author(s):

Michelle S Kars ◽

Benjamin Villacres Mori ◽

Seungjun Ahn ◽

Sara Merwin ◽

Stephen Wendolowski ◽

...

Keyword(s):

Length Of Stay ◽

Pain Score ◽

Postoperative Nausea ◽

Postoperative Nausea And Vomiting ◽

Opioid Consumption ◽

Surgical Correction ◽

Acute Tolerance ◽

Remifentanil Infusion ◽

Pain Scores ◽

Extubation Time

IntroductionOpioid-induced hyperalgesia (OIH) and acute opioid tolerance have been demonstrated extensively in patients undergoing adolescent idiopathic scoliosis (AIS) repair. Remifentanil infusion has been strongly linked to both tolerance and OIH in these patients; however, the impact of using an intraoperative fentanyl infusion has not been well studied. This study aims to determine if patients undergoing operative management of AIS have decreased opioid consumption and pain scores when an intraoperative fentanyl infusion is used as compared with a remifentanil infusion.MethodsThis is a retrospective chart review of patients with AIS who underwent posterior spinal fusion. During the period January 2012–June 2013, patients received remifentanil infusion as part of total intravenous anesthesia. From July 2013 to June 2015, remifentanil was replaced by fentanyl as standard protocol. The remifentanil cohort included 37 patients and the fentanyl cohort included 25 patients. The primary outcome was the total opioid consumption (morphine equivalents) in the first 24 hours postsurgery. Secondary outcomes included mean postoperative pain score in the first 24 hours postsurgery, postoperative opioid consumption 24–48 hours after surgery, time to extubation, time to assisted ambulation, length of stay, and incidence of postoperative nausea and vomiting.ResultsCompared with the remifentanil group, the fentanyl group had significantly higher postoperative opioid usage during the first 48 hours and significantly higher postoperative mean pain score during the first 24 hours. There was no difference between the two groups in mean pain score for 24–48 hours, extubation time, time to assisted ambulation, length of stay, or postoperative nausea and vomiting.DiscussionDespite concerns for hyperalgesia and acute tolerance, remifentanil is widely used for intraoperative opioid infusions for surgical correction of AIS. This retrospective study examined a practice change from intraoperative remifentanil to intraoperative fentanyl as a potential approach to avoid OIH. Surprisingly, patients receiving fentanyl intraoperatively showed increased postoperative opioid use and pain scores in the first 24 hours postsurgery compared with the prior cohort receiving remifentanil. Substitution of fentanyl for remifentanil during surgical correction of AIS does not appear to solve the problem of OIH or acute tolerance. Prospective studies are needed to confirm this unexpected result.

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Association of Increasing Frailty with Detrimental Outcomes after Pancreatic Resection

The American Surgeon ◽

10.1177/000313481808400423 ◽

2018 ◽

Vol 84 (4) ◽

pp. 512-519 ◽

Cited By ~ 1

Author(s):

Rodney Lane Guyton ◽

Catalina Mosquera ◽

Konstantinos Spaniolas ◽

Timothy L. Fitzgerald

Keyword(s):

Length Of Stay ◽

Distal Pancreatectomy ◽

Pancreatic Resection ◽

Odds Ratio ◽

Pancreatic Surgery ◽

Significant Risk ◽

Median Length ◽

Risk Of Death ◽

Frail Patients ◽

The Impact

An association between detrimental outcomes and frailty has been documented; however, the impact specific to pancreatic surgery is unknown. Using NSQIP data, patients were classified as non-, mildly, moderately, or severely frail. A total of16,028 patients were included inthe study; most of the patients were white (78.5%) and underwent pancreaticoduodenectomy (PD) (67%). Complications occurred in 17.6 per cent cases, and the median length of stay (LOS) was 11.89 days. Prolonged LOS and mortality occurred in 9.1 and 2.3 per cent of the cases. In the PD group, most of the patients were mildly frail (40.6%), followed by nonfrail (39.83%), whereas in the distal pancreatectomy (DP) group, the majority were nonfrail (43.82%), followed by mildly frail (39.37%) ( P < 0.0001). The 30-day complications, mortality, and LOS were significantly higher in patients undergoing PD compared with DP (19.5 vs 14.3%, 2.8 vs 1.2%, and 13.4 vs 8.7 days, respectively; P < 0.0001). PD conferred a significantly higher risk of death in all frailty groups compared with DP [nonfrail: odds ratio (OR) 1.76, mildly frail: OR 1.03, moderately frail: OR 2.03, P < 0.05], with the exception of severely frail patients. Compared with DP, PD conferred a significant risk of complication in all the frailty groups. Increases in frailty are associated with poorer outcomes after pancreatectomy.

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The effect of oxycodone on postoperative pain and inflammatory cytokine release in elderly patients undergoing laparoscopic gastrectomy

10.21203/rs.3.rs-102998/v1 ◽

2020 ◽

Author(s):

Wei-long Lao ◽

Qi-liang Song ◽

Zong-ming Jiang ◽

Wen-di Chen ◽

Xian-he Zheng ◽

...

Keyword(s):

Postoperative Pain ◽

Elderly Patients ◽

Laparoscopic Gastrectomy ◽

Rating Scale ◽

Visceral Pain ◽

Numerical Rating Scale ◽

Pulmonary Inflammation ◽

Postoperative Nausea And Vomiting ◽

Numerical Rating ◽

American Society

Abstract Background To evaluate the effect of oxycodone on postoperative pain and inflammation in elderly patients undergoing laparoscopic gastrectomy. Methods Sixty patients who were of both sexes, American Society of Anesthesiologists Physical Status (ASA-PS) Class I or II, over 65 years of age and undergoing an elective laparoscopic radical gastrectomy were randomly divided into two groups: an oxycodone group (Group O) and a sufentanil group (Group S). The postoperative analgesia regimen was as follows: 40 mg of parecoxib sodium and 0.1 mg/kg of oxycodone was intravenously injected into Group O before the abdomen closure, while 40 mg of parecoxib sodium and 0.1 μg/kg of sufentanil was injected intravenously into Group S. Both groups were infiltrated with 20 ml of 1% ropivacaine at the end of the operation. The concentrations of IL-6 and IL-10 were measured immediately after the operation and one hour, six hours and twenty-four hours after the operation (T1-4). The numerical rating scale (NRS), the Ramsay sedation score, analgesic-related adverse events, postoperative pulmonary inflammation events and the postoperative stay were recorded. Results Compared with Group S, the serum IL-6 concentrations of Group O decreased at T3 and T4, while the serum IL-10 concentrations increased (P < 0.05). In Group O, the serum IL-6 concentrations at T3 and T4 were lower than those at T1 (P < 0.05). The incidence of postoperative nausea and vomiting（PONV）and pulmonary inflammation in Group O was lower than that in Group S (P < 0.05). At each time point, the NRS of visceral pain in Group O was lower than that in Group S. At six and twenty-four hours after extubation, the NRS of incision pain in Group O was lower than that in Group S (P < 0.05). Conclusion Oxycodone can regulate the level of inflammatory cytokines and reduce postoperative inflammatory response.

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Pectoral Nerve Blocks for Breast Augmentation Surgery: A Randomized, Double-blind, Dual-centered Controlled Trial

Anesthesiology ◽

10.1097/aln.0000000000003855 ◽

2021 ◽

Author(s):

Yassir Aarab ◽

Severin Ramin ◽

Thomas Odonnat ◽

Océane Garnier ◽

Audrey Boissin ◽

...

Keyword(s):

Nerve Block ◽

Breast Augmentation ◽

Rating Scale ◽

Numerical Rating Scale ◽

Opioid Consumption ◽

Block Group ◽

Nerve Blocks ◽

Pectoral Nerve ◽

Numerical Rating ◽

Aesthetic Breast

Background Pectoral nerve blocks have been proposed for analgesia during and after breast cancer surgery, but data are conflicted in aesthetic breast surgery. This trial tested the primary hypothesis that adding a preincisional pectoral nerve block is superior to systemic multimodal analgesic regimen alone for pain control after breast augmentation surgery. A second hypothesis is that rescue opioid consumption would be decreased with a long-lasting effect for both outcomes during the following days. Methods Seventy-three adult female patients undergoing aesthetic breast augmentation surgery under general anesthesia were randomly allocated to receive a pectoral nerve block versus no block. Both groups received standard care with protocolized multimodal analgesia alone including systematic acetaminophen and nonsteroidal anti-inflammatory drugs. The primary outcome measure was the maximal numerical rating scale in the first 6 h after extubation. Secondary outcomes included intraoperative remifentanil consumption and from extubation to day 5: maximal numerical rating scale, postoperative cumulative opioid consumption and postoperative opioid side effects, and patient satisfaction recorded at day 5. Results The maximal numerical rating scale score in the first 6 h was lower in the pectoral nerve block group compared with the control group (3.9 ± 2.5 vs. 5.2 ± 2.2; difference: –1.2 [95% CI, –2.3 to –0.1]; P = 0.036). The pectoral nerve block group had a lower maximal numerical rating scale between days 1 and 5 (2.2 ± 1.9 vs. 3.2 ± 1.7; P = 0.032). The cumulative amount of overall opioids consumption (oral morphine equivalent) was lower for the pectoral nerve block group from hour 6 to day 1 (0.0 [0.0 to 21.0] vs. 21.0 [0.0 to 31.5] mg, P = 0.006) and from days 1 to 5 (0.0 [0.0 to 21.0] vs. 21.0 [0.0 to 51] mg, P = 0.002). Conclusions Pectoral nerve block in conjunction with multimodal analgesia provides effective perioperative pain relief after aesthetic breast surgery and is associated with reduced opioid consumption over the first 5 postoperative days. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Analgesic efficacy of intrathecal morphine and bupivacaine during the early postoperative period in patients who underwent robotic-assisted laparoscopic prostatectomy: a prospective randomized controlled study

BMC Urology ◽

10.1186/s12894-021-00798-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jung-Woo Shim ◽

Yun Jeong Cho ◽

Hyong Woo Moon ◽

Jaesik Park ◽

Hyung Mook Lee ◽

...

Keyword(s):

Rating Scale ◽

Intrathecal Morphine ◽

Information Service ◽

Analgesic Efficacy ◽

Early Postoperative Period ◽

Opioid Consumption ◽

Controlled Study ◽

Research Information ◽

Robotic Assisted ◽

Laparoscopic Prostatectomy

Abstract Background The present study was performed to investigate the analgesic efficacy of intrathecal morphine and bupivacaine (ITMB) in terms of treating early postoperative pain in adult patients who underwent robotic-assisted laparoscopic prostatectomy (RALP). Methods Fifty patients were prospectively enrolled and randomly classified into the non-ITMB (n = 25) and ITMB (n = 25) groups. The ITMB therapeutic regimen consisted of 0.2 mg morphine and 7.5 mg bupivacaine (total 1.7 mL). All patients were routinely administered the intravenous patient-controlled analgesia and appropriately treated with rescue intravenous (IV) opioid drugs, based on the discretion of the attending physicians who were blinded to the group assignments. Cumulative IV opioid consumption and the numeric rating scale (NRS) score were assessed at 1, 6, and 24 h postoperatively, and opioid-related complications were measured during the day after surgery. Results Demographic findings were comparable between patients who did and did not receive ITMB. The intraoperative dose of remifentanil was lower in the ITMB group than in the non-ITMB group. Pain scores (i.e., NRS) at rest and during coughing as well as cumulative IV opioid consumption were significantly lower in patients who received ITMB than in those who did not in the post-anesthesia care unit (PACU; i.e., at 1 h after surgery) and the ward (i.e., at 6 and 24 h after surgery). ITMB was significantly associated with postoperative NRS scores of ≤ 3 at rest and during coughing in the PACU (i.e., at 1 h after surgery) before and after adjusting for cumulative IV opioid consumption. In the ward (i.e., at 6 and 24 h after surgery), ITMB was associated with postoperative NRS scores of ≤ 3 at rest and during coughing before adjusting for cumulative IV opioid consumption but not after. No significant differences in complications were observed, such as post-dural puncture headache, respiratory depression, nausea, vomiting, pruritus, or neurologic sequelae, during or after surgery. Conclusion A single spinal injection of morphine and bupivacaine provided proper early postoperative analgesia and decreased additional requirements for IV opioids in patients who underwent RALP. Trial registration: Clinical Research Information Service, Republic of Korea; approval number: KCT0004350 on October 17, 2019. https://cris.nih.go.kr/cris/en/search/search_result_st01.jsp?seq=15637

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Liposome Bupivacaine for Postsurgical Analgesia in Patients Undergoing Robotically Assisted Cardiac Surgery

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000190 ◽

2015 ◽

Vol 10 (6) ◽

pp. 416-419 ◽

Cited By ~ 3

Author(s):

Husam H. Balkhy ◽

Susan Arnsdorf ◽

Dorothy Krienbring ◽

John Urban

Keyword(s):

Cardiac Surgery ◽

Postoperative Nausea ◽

Rating Scale ◽

Statistical Significance ◽

Postoperative Nausea And Vomiting ◽

Opioid Consumption ◽

Nausea And Vomiting ◽

Postsurgical Pain ◽

Liposome Bupivacaine ◽

The Impact

Objective Despite the advantages of robotically assisted cardiac surgery over conventional open sternotomy, robotically assisted surgery may be associated with substantial postsurgical pain arising from multiple incisions and access ports. This single-site, retrospective chart review evaluated the impact of liposome bupivacaine compared with bupivacaine HCl on postsurgical pain management in patients undergoing robotically assisted endoscopic cardiac surgery. Methods Sequential patient cohorts undergoing robotically assisted cardiac surgery received either 0.25% bupivacaine HCl (100 mg in 40 mL, n = 30) or liposome bupivacaine (266 mg in 20 mL, expanded to 40 mL with 0.9% sterile normal saline, n = 30) intraoperatively via equal-volume infiltration across port sites. Outcome measures, collected from the day of surgery through postoperative day 3, were daily and total use of opioid analgesics (converted to morphine equivalents), pain intensity (11-point numeric rating scale), and incidence of postoperative nausea and vomiting. Results Median length of hospital stay was 4 days in the liposome bupivacaine group and 3 days in the bupivacaine HCl group. Patients receiving liposome bupivacaine had numerically lower mean pain scores (at six of seven time points), reduced mean opioid consumption, and a reduced incidence of postoperative nausea and vomiting compared with those receiving bupivacaine HCl, although none of the differences reached statistical significance. Conclusions Results from this small retrospective, observational study suggest that liposome bupivacaine may improve postsurgical pain relief and reduce postsurgical opioid consumption, in comparison with bupivacaine HCl, in patients undergoing robotically assisted cardiac surgery. Larger prospective studies of liposome bupivacaine in this setting are warranted.

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