Peripheral nerve blocks with liposomal bupivacaine are associated with increased opioid use compared to thoracic epidural in patients with an epigastric incision.

Autor: Aiken TJ; Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA., Padilla E; School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA., Lemaster D; Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA., Ronnekleiv-Kelly S; Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA.; Division of Surgical Oncology, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA., Weber S; Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA.; Division of Surgical Oncology, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA., Minter RM; Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA.; Division of Surgical Oncology, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA., Ethier S; Department of Anesthesiology, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA., Abbott DE; Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA.; Division of Surgical Oncology, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA.
Jazyk: angličtina
Zdroj: Journal of surgical oncology [J Surg Oncol] 2022 Mar; Vol. 125 (3), pp. 387-391. Date of Electronic Publication: 2021 Oct 07.
DOI: 10.1002/jso.26711
Abstrakt: Background: Thoracic epidurals are commonly recommended in enhanced recovery protocols, though they may cause hypotension and urinary retention. Peripheral nerve blocks using liposomal bupivacaine are a potential alternative, though they have not been extensively studied in major cancer operations with an epigastric incision.
Methods: We conducted a retrospective review of prospectively collected data following the transition from thoracic epidural to liposomal peripheral nerve blocks in patients undergoing major oncologic surgery. Patients receiving peripheral nerve blocks were compared to those receiving thoracic epidural. Outcome variables included postoperative opioid use (milligram morphine equivalents [MME]), severe pain, and postoperative complications.
Results: Forty-seven of 102 patients studied (46%) received peripheral nerve blocks. Opioid use was higher in the peripheral nerve block group during the 0-24 h (116 vs. 94 MME, p = 0.04) and 24-48 h postoperative period (94 vs. 23 MME, p < 0.01). There was no significant difference in severe pain, hypotension, urinary retention, or ileus. Peripheral nerve blocks were associated with earlier ambulation (1 vs. 2 days, p = 0.04), though other milestones were similar.
Conclusions: Liposomal peripheral nerve blocks were associated with increased opioid use compared to thoracic epidural. On the basis of our results, thoracic epidural might be preferred in surgical oncology patients with an epigastric incision.
(© 2021 Wiley Periodicals LLC.)
Databáze: MEDLINE
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