Abstract
Background
Veterans have disproportionate risk of opioid misuse and abuse compared to the civilian
population. Managing acute postoperative pain without opioids is of the utmost importance
for the Veteran patient population. This pilot study evaluates a novel multimodal
opioid-free pain control regimen by assessing postoperative pain in Veterans undergoing
robotic-assisted radical prostatectomy (RARP).
Methods
Prospective data was collected from patients undergoing RARP at a Department of Veterans
Affairs Medical Center. Patients in the opioid-cohort received tramadol, hydrocodone-acetaminophen,
or oxycodone-acetaminophen postoperatively. The opioid-free novel multimodal approach
consisted of 100 mg gabapentin TID, 15 mg ketorolac Q6 hours, and 1 mg scheduled IV
acetaminophen Q6 hours. Pain scores were collected using a visual analogue pain scale
on postoperative days 0 and 1.
Results
Data was collected from 57 patients, 33 treated with opioids and 24 with the opioid-free
pathway. There were no significant differences in demographics (P > .05) between cohorts. No significant differences were observed for preoperative
and intraoperative variables (P > .05). Average postoperative day 0 pain scores for opioid-free (2.2 ± 3.1) and opioid
treatments (3.1 ± 3.1) were not statistically different (P = .1321). Postoperative day 1 differences of average pain scores for opioid-free
(0.9 ± 1.9) and opioid (1.6 ± 3.1) treatments were not statistically significant (P = .1647).
Conclusions
The novel multimodal opioid-free treatment in this study may be effectively utilized
for postoperative pain during hospital recovery of Veterans undergoing RARP. Future
directions include a randomized control clinical trial in the general population.
Keywords
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References
- Trends and geographic patterns in drug and synthetic opioid overdose deaths—United States, 2013–2019.Morb Mortal Wkly Rep. 2021; 70: 202-207https://doi.org/10.15585/mmwr.mm7006a4
- Accidental poisoning mortality among patients in the department of veterans affairs health system.Med Care. 2011; 49: 393-396https://doi.org/10.1097/MLR.0b013e318202aa27
- Addressing the opioid epidemic in the United States.JAMA. 2017; 177: 611https://doi.org/10.1001/jamainternmed.2017.0147
- Changing trends in opioid overdose deaths and prescription opioid receipt among veterans.Am J Prev Med. 2019; 57: 106-110https://doi.org/10.1016/j.amepre.2019.01.016
- New persistent opioid use after minor and major surgical procedures in US adults.JAMA Surg. 2017; 152e170504https://doi.org/10.1001/jamasurg.2017.0504
- The incidence of persistent postoperative opioid use among U.S. veterans: a national study to identify risk factors.J Clin Anesth. 2021; 68110079https://doi.org/10.1016/j.jclinane.2020.110079
- Evaluating the opioid epidemic: a urologist's promise to curb the crisis.Transl Androl Urol. 2021; 10: 19-21https://doi.org/10.21037/tau-2020-899
- Patient satisfaction and pain control using an opioid-sparing postoperative pathway.J Am Coll Surg. 2019; 229: 316-322https://doi.org/10.1016/j.jamcollsurg.2019.04.020
- Effect of a prospective opioid reduction intervention on opioid prescribing and use after radical prostatectomy: results of the opioid reduction intervention for open, laparoscopic, and endoscopic surgery (ORIOLES) initiative.BJU Intl. 2020; 125: 426-432https://doi.org/10.1111/bju.14932
- Preventing excess narcotic prescriptions in new robotic surgery discharges: the PENN prospective cohort quality improvement initiative.J Endourol. 2019; 34: 48-53https://doi.org/10.1089/end.2019.0362
- Ultrasound-guided transversus abdominis plane block (US-TAPb) for robot-assisted radical prostatectomy: a novel '4-point' technique-results of a prospective, randomized study [published correction appears in J Robot Surg. 2018 Aug 14;:].J Robot Surg. 2019; 13: 147-151https://doi.org/10.1007/s11701-018-0858-6
- Preemptive multimodal pain regimen reduces opioid analgesia for patients undergoing robotic-assisted laparoscopic radical prostatectomy.Urology. 2010; 76: 1122-1124https://doi.org/10.1016/j.urology.2010.03.052
- Safe transition to opioid-free pathway after robotic-assisted laparoscopic prostatectomy.J Rob Surg. 2021; https://doi.org/10.1007/s11701-021-01237-0
- A review of opioid-sparing modalities in perioperative pain management: methods to decrease opioid use postoperatively.Anesth Analg. 2017; 125: 1749-1760https://doi.org/10.1213/ANE.0000000000002497
- Gabapentin: pharmacology and its use in pain management.Anesthesia. 2002; 57: 451-462https://doi.org/10.1046/j.0003-2409.2001.02399.x
- Use of gabapentin for perioperative pain control—a meta-analysis.Pain Res Manage. 2007; 12: 85-92https://doi.org/10.1155/2007/840572
- Effect of perioperative gabapentin on postoperative pain resolution and opioid cessation in a mixed surgical cohort: a randomized clinical trial.JAMA Surg. 2018; 153: 303https://doi.org/10.1001/jamasurg.2017.4915
Acetaminophen. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com.
- PMH31 - evaluation of the burden of opioid abuse among US veteran patients.Value Health. 2015; 18: A411https://doi.org/10.1016/j.jval.2015.09.984
- Value for taxpayers' dollars: what VA care would cost at medicare prices.Med Care Res Rev. 2004; 61: 495-508
- Estimating private sector values for VA health care: an overview.Med Care. 2003; 41: II2-II10
Article Info
Publication History
Published online: May 10, 2022
Accepted:
May 2,
2022
Received in revised form:
May 2,
2022
Received:
October 15,
2021
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
