Quantifying the impact of reduced opioid use in patients after emergency laparotomy. Surgery 2023 Jun;173(6):1499-1507
Date
03/23/2023Pubmed ID
36948914DOI
10.1016/j.surg.2023.02.009Scopus ID
2-s2.0-85150774415 (requires institutional sign-in at Scopus site)Abstract
BACKGROUND: Emergency laparotomies have high rates of morbidity and mortality. The evaluation and management of pain are crucial, as poorly managed pain may contribute to postoperative complications and increase the risk of mortality. This study aims to describe the relationship between opioid use and opioid-related adverse effects and identify what constitutes appropriate dose reductions to elicit clinically relevant benefits.
METHODS: This was a retrospective, observational study of patients presenting for emergency laparotomy due to trauma from 2014 to 2018. The primary objective was to define clinical outcomes that may be significantly affected by changes in milligrams of morphine equivalent during the first 72 hours postoperatively; additionally, we sought to quantify the approximate differences in morphine equivalent that correlate with clinically meaningful outcomes such as hospital length of stay, pain scores, and time to first bowel movement. For descriptive summaries, patients were categorized into low, moderate, and high groups based on morphine equivalent requirements of 0 to 25, 25 to 50, and >50, respectively.
RESULTS: A total of 102 (35%), 84 (29%), and 105 (36%) patients were stratified into the low, moderate, and high groups, respectively. Mean pain scores for postoperative days 0 to 3 (P = .034), time to first bowel movement (P = .002), and nasogastric tube duration (P = .003) were the clinical outcomes found to be significantly associated with morphine equivalent. Estimated clinically significant reductions in morphine equivalent for these outcomes ranged from 194 to 464.
CONCLUSION: Clinical outcomes, such as pain scores, and opioid-related adverse effects, such as time to first bowel movement and nasogastric tube duration, may be linked with the amount of opioids used.
Author List
Tchen S, Bhatt R, Peppard W, Szabo A, Dong H, Morris R, Trevino CMAuthors
Rachel S. Morris MD Assistant Professor in the Surgery department at Medical College of WisconsinWilliam J. Peppard PharmD Trauma/Surgical Critical Care Pharmacist in the Pharmacy department at Froedtert Hospital
Aniko Szabo PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Colleen Trevino PhD APP Clinical Dir Inpatient 2 in the Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Analgesics, OpioidHumans
Laparotomy
Morphine
Opioid-Related Disorders
Pain, Postoperative
Retrospective Studies
