Inpatient Opioid Use After Pancreatectomy: Opportunities for Reducing Initial Opioid Exposure in Cancer Surgery Patients

• Published in: Annals of surgical oncology 2019-10, Vol.26 (11), p.3428-3435
• Main Authors: Newhook, Timothy E., Dewhurst, Whitney L., Vreeland, Timothy J., Wang, Xuemei, Soliz, Jose, Speer, B. Bryce, Hancher-Hodges, Shannon, Feng, Chun, Bruno, Morgan L., Kim, Michael P., Aloia, Thomas A., Vauthey, Jean-Nicolas, Lee, Jeffrey E., Katz, Matthew H. G., Tzeng, Ching-Wei D.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Analgesia; Analgesics; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - standards; ANESTHETICS; Decision making; Female; Follow-Up Studies; Health Services Research and Global Oncology; Humans; Inpatients - statistics & numerical data; Intravenous administration; Male; Medicine; Medicine & Public Health; Middle Aged; MORPHINE; Narcotics; NEOPLASMS; Oncology; Opioids; Pain perception; Pain, Postoperative - diagnosis; Pain, Postoperative - drug therapy; Pain, Postoperative - etiology; PANCREAS; Pancreatectomy; Pancreatectomy - adverse effects; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Pancreaticoduodenectomy; PATIENTS; Prognosis; RADIOLOGY AND NUCLEAR MEDICINE; Retrospective Studies; SURGERY; Surgical Oncology; Weaning
• ISSN: 1068-9265; 1534-4681; 1534-4681
• DOI: 10.1245/s10434-019-07528-z

Background Despite advances in enhanced surgical recovery programs, strategies limiting postoperative inpatient opioid exposure have not been optimized for pancreatic surgery. The primary aims of this study were to analyze the magnitude and variations in post-pancreatectomy opioid administration and to characterize predictors of low and high inpatient use. Methods Clinical characteristics and inpatient oral morphine equivalents (OMEs) were downloaded from electronic records for consecutive pancreatectomy patients at a high-volume institution between March 2016 and August 2017. Regression analyses identified predictors of total OMEs as well as highest and lowest quartiles. Results Pancreatectomy was performed for 158 patients (73% pancreaticoduodenectomy). Transversus abdominus plane (TAP) block was performed for 80% ( n  = 127) of these patients, almost always paired with intravenous patient-controlled analgesia (IV-PCA), whereas 15% received epidural alone. All the patients received scheduled non-opioid analgesics (median, 2). The median total OME administered was 423 mg (range 0–4362 mg). Higher total OME was associated with preoperative opioid prescriptions ( p