1. Robot-assisted laparoscopic nephrectomy: early outcome measures with the implementation of multimodal analgesia and intrathecal morphine via the acute pain service.
- Author
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Meineke, Minhthy, Losli, Matthew, Sztain, Jacklynn, Swisher, Matthew, Abramson, Wendy, Martin, Erin, Salmasi, Amirali, Derweesh, Ithaar, Gabriel, Rodney, Said, Engy, and Furnish, Timothy
- Subjects
Acute pain service ,Intrathecal morphine ,Multimodal analgesia ,Robotic nephrectomy ,Humans ,Pain Clinics ,Retrospective Studies ,Morphine ,Analgesics ,Opioid ,Robotics ,Pain ,Analgesia ,Nephrectomy ,Laparoscopy - Abstract
PURPOSE: 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. METHODS: 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. RESULTS: 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
- Published
- 2024