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Enhanced Recovery and Opioid-Sparing Pain Management Following Lung Transplantation
- Source :
- The Journal of Heart and Lung Transplantation. 39:S95
- Publication Year :
- 2020
- Publisher :
- Elsevier BV, 2020.
-
Abstract
- Purpose Adequate pain control is essential following lung transplantation to reduce patient stress and minimize perioperative complications. Enhanced recovery after surgery (ERAS) protocols have demonstrated improvements in patient experience and reduced length of stay. However, the implementation of these protocols has not yet extended to the lung transplant population. Methods We retrospectively reviewed all lung transplant recipients (LTR) at our institution from February 2018 to August 2019. An opioid-sparing, multimodal pain regimen was implemented that included preemptive analgesia with gabapentin and acetaminophen (APAP) pre-transplant; liposomal bupivacaine intercostal nerve block (INB) in the operating room; and a combination of APAP, gabapentin, and methocarbamol post-op with opioids given as indicated. Serratus anterior plane block was used for refractory pain. Results In total, we reviewed 48 LTR. The mean LAS was 43.74 and 21% were on mechanical ventilation or ECMO pre-transplant. Frequency of protocol adherence for each agent was as follows: liposomal bupivacaine INB (71%), APAP (100%), gabapentin (98%), methocarbamol (27%), and ketorolac (33%). Seven patients (15%) required a serratus plane block for refractory pain. Pain scores peaked at a median of 5 on postoperative day (POD) 1 and declined to a median of 3 by POD 3. By POD 4 only 54% of patients were still receiving opioids at a median of 15 mg oral morphine equivalents per day (IQR, 0-59). Only 3 patients were discharged on opioids and they were all on opioids pre-transplant. The median duration of mechanical ventilation was 1 day (IQR, 0.64-1.69) and 81% were extubated before 48 hours. The median hospital length of stay was 8 days (IQR, 6-15) and 30-day mortality was 0%. Conclusion Enhanced recovery and opioid-sparing pain protocols are feasible in LTR leading to minimal opioid use and acceptable pain scores. Outcomes with ERAS protocols should be compared to standard-of-care postoperative management.
- Subjects :
- Pulmonary and Respiratory Medicine
Gabapentin
medicine.medical_treatment
Population
030204 cardiovascular system & hematology
03 medical and health sciences
0302 clinical medicine
0502 economics and business
medicine
Lung transplantation
education
Mechanical ventilation
Transplantation
education.field_of_study
business.industry
05 social sciences
Perioperative
Acetaminophen
Ketorolac
Anesthesia
050211 marketing
Surgery
Cardiology and Cardiovascular Medicine
business
medicine.drug
Intercostal nerve block
Subjects
Details
- ISSN :
- 10532498
- Volume :
- 39
- Database :
- OpenAIRE
- Journal :
- The Journal of Heart and Lung Transplantation
- Accession number :
- edsair.doi...........e8b4d1604d42931dd4fe4bedd0e665eb
- Full Text :
- https://doi.org/10.1016/j.healun.2020.01.939