Effect of epidural analgesia on postoperative opioid requirements following elective laparotomies performed at Vancouver General Hospital - 20/05/21

Doi : 10.1016/j.amjsurg.2021.03.025

Philemon Leung ^a, Abdullah A. Albarrak ^b,^{^{1
Shared co-first authorship.}}, Aida Rahavi ^c, Vahid Mehrnoush ^a, Alex Lee ^d, Leo Chen ^a, Adam Meneghetti ^e,^⁎
^a Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, British Columbia, V5Z 1M9, Canada
^b Department of Surgery, College of Medicine, Majmaah University, Industrial Area, Al Majma’ah, 15341, Saudi Arabia
^c Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, British Columbia, V5Z 1M9, Canada
^d Faculty of Medicine, University of Ottawa, Roger Guindon Hall, 451 Smyth Rd., Ottawa, Ontario, K1H 8M5, Canada
^e Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 5th Floor, Vancouver, British Columbia, V5Z 1M9, Canada

^∗Corresponding author. Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, 5th Floor, Vancouver, BC, V5Z 1M9, Canada.Gordon and Leslie Diamond Health Care Centre2775 Laurel Street5th FloorVancouverBCV5Z 1M9Canada

Abstract

Background

Enhanced recovery pathways aim to reduce postoperative opioid use and opioid-related complications. These pathways often include epidural analgesia (EA). This study examines postoperative opioid use after elective laparotomy with and without EA.

Methods

Retrospective chart review of elective laparotomies performed by General Surgery at a tertiary academic center during 2017 was completed. Primary outcome was postoperative opioid usage. Secondary outcomes were time to mobilization, duration of urinary catheterization and postoperative ileus.

Results

Among 236 patients, 213 (90%) received EA. There was no significant difference in mean total oral morphine equivalent (OME) usage between EA and non-EA groups. Mean OME use on postoperative day three was higher in the EA group (38.0 vs 22.4 mg, p = 0.02). On multivariate analysis, preoperative opioid use was associated with increased postoperative OME consumption (regression coefficient 147.5, p < 0.001).

Conclusions

In this cohort, epidural analgesia did not reduce postoperative opioid consumption.

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Highlights

•	Current enhanced recovery pathways emphasize reducing postoperative opioid use.
•	Epidural analgesia was not associated with reduced postoperative opioid use.
•	History of preoperative opioid use is associated with postoperative opioid use.

Le texte complet de cet article est disponible en PDF.

Keywords : Postoperative opioid use, Epidural analgesia, Enhanced recovery after surgery, Elective laparotomy

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Vol 221 - N° 6

P. 1228-1232 - juin 2021 Retour au numéro

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Effect of epidural analgesia on postoperative opioid requirements following elective laparotomies performed at Vancouver General Hospital - 20/05/21

Abstract

Background

Methods

Results

Conclusions

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