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The Implementation of an Acute Pain Service for Patients Undergoing Open Ventral Hernia Repair with Mesh and Abdominal Wall Reconstruction

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Abstract

Introduction

In this retrospective cohort single-institutional study, we report the outcomes of implementing a standardized protocol of multimodal pain management with thoracic epidural analgesia via the acute pain service (APS) for patients undergoing ventral hernia repair with mesh placement and abdominal wall reconstruction.

Methods

The primary outcome evaluated was postoperative 72-h opioid consumption, measured in intravenous morphine equivalents (MEQ). Secondary outcomes included hospital length of stay (LOS) among other outcomes. The two cohorts were the APS versus non-APS group, in which the former cohort had an APS providing epidural and multimodal analgesia and the latter utilized pain management per surgical team, which mostly consisted of opioid therapy. Using1:1 propensity-score-matched cohorts, Wilcoxon signed-rank test was used to calculate the differences in outcomes. A p < 0.05 was considered statistically significant.

Results

There were 83 patients, wherein 51 (61.4%) were in the APS group. Between matched cohorts, the non-APS cohort’s median [quartiles] total opioid consumption during the first three days was 85.6 mg MEQs [58.9, 112.8 mg MEQs]. The APS cohort was 31.7 mg MEQs [16.0, 55.3 mg MEQs] (p < 0.0001). The non-APS hospital LOS median [quartiles] was 5 days [4, 7 days] versus 4 days [4, 5 days] in the APS group (p = 0.01).

Discussion

A dedicated APS was associated with decreased opioid consumption by 75%, as well as a decreased hospital LOS. We report no differences in ICU length of stay, time to oral intake, time to ambulation or time to urinary catheter removal.

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Abbreviations

APS:

Acute pain service

ASA:

American Society of Anesthesiologists

BMI:

Body mass index

ERAS:

Enhanced recovery after surgery

ICU:

Intensive care unit

IRB:

Institutional review board

LOS:

Length of stay

MEQ:

Intravenous morphine equivalents

OR:

Operating room

PO:

Per oral

PRN:

As needed

TEA:

Thoracic epidural analgesia

VHR:

Ventral hernia repair

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Authors and Affiliations

  1. Department of Anesthesiology, Division of Regional Anesthesia and Acute Pain Medicine, University of California, 9400 Campus Point Dr, MC 7770, La Jolla, San Diego, CA, 92037, USA

    Engy T. Said, Ross E. Drueding, Erin I. Martin, Timothy J. Furnish, Minhthy N. Meineke, Jacklynn F. Sztain, Wendy B. Abramson, Matthew W. Swisher & Rodney A. Gabriel

  2. Department of Surgery, Division of Minimally Invasive Surgery, University of California, La Jolla, San Diego, CA, USA

    Garth R. Jacobsen

  3. Department of Surgery, Division of Plastic Surgery, University of California, La Jolla, San Diego, CA, USA

    Amanda A. Gosman

  4. Department of Medicine, Division of Biomedical Informatics, University of California, 9400 Campus Point Dr, MC 7770, La Jolla, San Diego, CA, 92037, USA

    Rodney A. Gabriel

Authors
  1. Engy T. Said
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  2. Ross E. Drueding
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  3. Erin I. Martin
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  4. Timothy J. Furnish
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  5. Minhthy N. Meineke
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  6. Jacklynn F. Sztain
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  7. Wendy B. Abramson
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  8. Matthew W. Swisher
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  9. Garth R. Jacobsen
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  10. Amanda A. Gosman
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  11. Rodney A. Gabriel
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Contributions

ES participated in patient care, study design, data collection, data analysis and manuscript preparation. RD, EM, TF, MM, JS, WA and MS participated in patient care, data collection and manuscript preparation. GJ and AG participated in patient care, study design and manuscript preparation. RG participated in patient care, study design, data collection, data analysis and manuscript preparation.

Corresponding author

Correspondence to Rodney A. Gabriel.

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The authors declare that they have no conflict of interest.

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Said, E.T., Drueding, R.E., Martin, E.I. et al. The Implementation of an Acute Pain Service for Patients Undergoing Open Ventral Hernia Repair with Mesh and Abdominal Wall Reconstruction. World J Surg 45, 1102–1108 (2021). https://doi.org/10.1007/s00268-020-05915-2

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  • DOI: https://doi.org/10.1007/s00268-020-05915-2

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