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Pilot study of a novel pain management strategy: evaluating the impact on patient outcomes

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Abstract

Background

Our objective was to evaluate the impact of a novel multimodal pain management strategy on intraoperative opioid requirements, postoperative pain, narcotic use, and length of stay.

Methods

Consecutive patients undergoing elective laparoscopic colorectal resection were managed with an experimental protocol. The protocol uses a post-induction, pre-incision bilateral TAP block and local peritoneal infiltration at port sites with long-acting liposomal bupivacaine (20 mL long-acting liposomal bupivacaine, 30 mL 0.25 % bupivacaine, 30 mL saline). Experimental patients were matched on age, body mass index, gender, comorbidity, diagnosis, and procedure to a control group that received no block or local wound infiltration. Both groups followed a standardized enhanced recovery pathway. Demographics, perioperative, and postoperative outcomes were evaluated. The main outcome measures were intraoperative opioids, postoperative pain, opioid use, and length of stay.

Results

Fifty patients were analyzed—25 experimental and 25 controls. Patients were well matched on all demographics. In both cohorts, the main diagnosis was colorectal cancer and primary procedure performed a segmental resection. Operative times were similar (p = 0.41). Experimental patients received significantly less intraoperative fentanyl (mean 158 mcg experimental vs. 299 mcg control; p < 0.01). The experimental group had significantly lower initial (p < 0.01) and final PACU pain scores (p = 0.04) and shorter LOS (3.0 vs. 4.1 days, p = 0.04) compared to controls. Experimental patients trended toward shorter PACU times and lower opioid use and daily pain scores throughout the hospital stay. Postoperative complication and readmission rates were similar across groups. There were no reoperations or mortality.

Conclusions

Our multimodal pain management strategy reduced intraoperative opioid administration. Postoperatively, improvements in PACU time, postoperative pain and narcotic use, and lengths of stay were seen in the experimental cohort. With the favorable finding from the pilot study, further investigation is warranted to fully evaluate the impact of this pain management protocol on patient satisfaction, clinical and financial outcomes.

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Acknowledgments

The authors acknowledge Madhu Ragupathi MD for data collection.

Funding

The authors received no funding or financial support for this project.

Author information

Authors and Affiliations

  1. Colorectal Surgical Associates LLP LTD, Houston, TX, USA

    DS Keller, JR Flores-Gonzalez & S. Ibarra

  2. Colorectal Surgical Associates LLP LTD, Division of Colon and Rectal Surgery, Houston Methodist Hospital, Minimally Invasive Colon and Rectal Surgery Fellowship, University of Texas Medical School at Houston, 6560 Fannin, Suite 1404, Houston, TX, 77030, USA

    EM Haas

  3. Colorectal Surgical Associates LLP LTD, Minimally Invasive Colon and Rectal Surgery, University of Texas Medical School at Houston, Houston, TX, USA

    RN Tahilramani

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  1. DS Keller
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  2. RN Tahilramani
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  5. EM Haas
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Corresponding author

Correspondence to DS Keller.

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Disclosures

Dr. Haas is a consultant for Pacira Pharmaceuticals, Inc. Drs. Keller, Tahilramani, Flores-Gonzalez, and Ibarra have no relevant conflicts of interest and nothing to disclose.

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Keller, D., Tahilramani, R., Flores-Gonzalez, J. et al. Pilot study of a novel pain management strategy: evaluating the impact on patient outcomes. Surg Endosc 30, 2192–2198 (2016). https://doi.org/10.1007/s00464-015-4459-4

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  • DOI: https://doi.org/10.1007/s00464-015-4459-4

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