Continuous Wound Irrigation and Intraoperative Methadone Decreases Opioid Use and Shortens Length of Stay After CRS/HIPEC.

Autor: Boesl MA; Department of General Surgery, University of Utah Health, Salt Lake City, UT, USA., Brown N; Department of General Surgery, University of Utah Health, Salt Lake City, UT, USA., Bleicher J; Department of General Surgery, University of Utah Health, Salt Lake City, UT, USA., Call T; Department of Anesthesiology, University of Utah Health, Salt Lake City, UT, USA., Lambert DH; Department of Anesthesiology, Boston University Medical Center, Boston, MA, USA., Lambert LA; Department of General Surgery, University of Utah Health, Salt Lake City, UT, USA. Laura.Lambert@hci.utah.edu.; Department of Surgical Oncology, Huntsman Cancer Institute, Salt Lake City, UT, USA. Laura.Lambert@hci.utah.edu.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2024 Jun; Vol. 31 (6), pp. 3742-3749. Date of Electronic Publication: 2024 Feb 01.
DOI: 10.1245/s10434-024-14900-1
Abstrakt: Background: Epidural analgesia is resource and labor intense and may limit postoperative management options and delay discharge. This study compared postoperative outcomes after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) with epidural analgesia versus continuous wound infusion system (CWIS) with/without intraoperative methadone.
Methods: A single-institution, retrospective chart review was performed including all patients undergoing open CRS/HIPEC from 2018 to 2021. Patient demographics, surgical characteristics, length of stay, and in-hospital analgesic use were reviewed. In-hospital opioid exposure in morphine milligram equivalents (MME) was calculated. Multivariate analysis (MVA) for mean total and daily opioid exposure was conducted.
Results: A total of 157 patients were included. Fifty-three (34%) had epidural analgesia, 96 (61%) had CWIS, and 79 (50%) received methadone. Length of stay was significantly shorter with CWIS + methadone versus epidural (7 vs. 8 days, p < 0.01). MVA showed significantly lower mean total and daily opioid exposure with CWIS+methadone versus epidural (total: 252.8 ± 17.7 MME vs. 486.8 ± 86.6 MME; odds ratio [OR] 0.72, 95% confidence interval [CI] 0.52-0.98, p = 0.04; Daily: 32.8 ± 2.0 MME vs. 51.9 ± 5.7 MME, OR 0.72, 95% CI 0.52-0.99, p ≤ 0.05). The CWIS-only group (n = 17) had a significantly lower median oral opioid exposure versus epidural (135 MME vs. 7.5 MME, p < 0.001) and longer length of stay versus CWIS + methadone (9 vs. 7 days, p = 0.04), There were no CWIS or methadone-associated complications and one epidural abscess.
Conclusions: CWIS + methadone safely offers better pain control with less in-hospital opioid use, shorter length of stay, and decreased resource utilization compared with epidural analgesia in patients undergoing CRS-HIPEC.
(© 2024. Society of Surgical Oncology.)
Databáze: MEDLINE
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