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Association of trainee involvement in an acute pain service with postoperative opioid use in patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

대한마취과학회지 2020년 73권 3호 p.219 ~ 223
Said Engy T., Sztain Jacklynn F., Martin Erin I., Abramson Wendy B., Meineke Minhthy N., Furnish Timothy J., Swisher Matthew W., Gabriel Rodney A.,
소속 상세정보
 ( Said Engy T. ) - University of California San Diego Department of Anesthesiology
 ( Sztain Jacklynn F. ) - University of California San Diego Department of Anesthesiology
 ( Martin Erin I. ) - University of California San Diego Department of Anesthesiology
 ( Abramson Wendy B. ) - University of California San Diego Department of Anesthesiology
 ( Meineke Minhthy N. ) - University of California San Diego Department of Anesthesiology
 ( Furnish Timothy J. ) - University of California San Diego Department of Anesthesiology
 ( Swisher Matthew W. ) - University of California San Diego Department of Anesthesiology
 ( Gabriel Rodney A. ) - University of California San Diego Department of Anesthesiology

Abstract


Background: Several hospitals have implemented a multidisciplinary Acute Pain Service (APS) to execute surgery-specific opioid sparing analgesic pathways. Implementation of an anesthesia attending-only APS has been associated with decreased postoperative opioid consumption, time to ambulation, and time to solid food intake for patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. In this study, we evaluated the impact of introducing an APS trainee on postoperative opioid consumption in patients undergoing hyperthermic intraperitoneal chemotherapy during postoperative day (POD) 0?3.

Methods: We performed a retrospective propensity-matched cohort study where we compared opioid consumption and hospital length of stay among two historical cohorts: attending-only APS service versus service involving a regional anesthesia fellow.

Results: In the matched cohorts, POD 0?3 opioid use [25%, 75% quartile] for the single attending and trainee involvement cohort were 38.5 mg morphine equivalents (MEQ) [14.1 mg, 106.3 mg] and 50.4 mg MEQ [28.4 mg, 91.2 mg], respectively. The median difference was ?9.8 mg MEQ (95% CI ?30.7 to 16.5 mg; P = 0.43). There was no difference in hospital length of stay between both cohorts (P = 0.67).

Conclusions: We found that the addition of a regional anesthesia fellow to the APS team was not associated with statistically significant differences in total opioid consumption or hospital length of stay in this surgical population. The addition of trainees to the infrastructure, with vigilant supervision, is not associated with change in outcomes.

키워드

Acute pain service; Epidural; Opioids; Trainee

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