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.
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.
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).
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.
World journal of urology. 2024 Mar 04*** epublish ***
Minhthy N Meineke, Matthew V Losli, Jacklynn F Sztain, Matthew W Swisher, Wendy B Abramson, Erin I Martin, Timothy J Furnish, Amirali Salmasi, Ithaar H Derweesh, Rodney A Gabriel, Engy T Said
Division of Acute Pain, Department of Anesthesiology, University of California, 9400 Campus Point Dr, San Diego, La Jolla, CA, 92037, USA., Department of Anesthesiology, University of California, San Diego, La Jolla, CA, USA., Department of Urology, University of California, San Diego, La Jolla, CA, USA., Division of Acute Pain, Department of Anesthesiology, University of California, 9400 Campus Point Dr, San Diego, La Jolla, CA, 92037, USA. .