Mavani Parit T, Sok Caitlin, Ajay Pranay S, McPherson Tarrant, Switchenko Jeffrey, Kooby David A, Shah Mihir M
Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Department of Biostatistics and Bioinformatics, Rollins School of Public Health of Emory University, Atlanta, Georgia, USA.
J Surg Oncol. 2025 Jun;131(7):1343-1351. doi: 10.1002/jso.28074. Epub 2025 Jan 8.
Opioid crisis is a national issue with significant economic burden and marked increase in opioid-related deaths, particularly following surgical procedures. Reducing opioid requirements while maintaining effective analgesia is critically challenging, perioperatively. Multimodal drug regimens and guided regional anesthesia (RA) have been adopted to address this issue. We aimed to assess postoperative opioid consumption in patients undergoing open pancreatoduodenectomy based on the routes of RA administration: open versus ultra-sound guided.
This retrospective cohort study was conducted at Emory University Saint Joseph's Hospital, encompassing patients who underwent open pancreatoduodenectomy (PD) from 2020 to 2022 who received ultrasound-guided RA (U-RA) or open RA (O-RA). Patient demographics, surgical details, and postoperative outcomes, including opioid consumption measured in morphine milligram equivalents (MME) at 24, 48, and 72 h, were analyzed. Multivariable linear regression identified predictors of postoperative opioid use.
Of 95 patients, 47 met inclusion criteria: 27 received U-RA and 20 O-RA. Preoperative and intraoperative characteristics were similar between patients receiving O-RA and U-RA. A lower opioid requirement was noted in the O-RA group compared to the U-RA group at all time points. (24 h: 6.5 vs. 18, p = 0.004; 48 h: 18 vs. 37, p = 0.001; 72 h: 30.5 vs. 57, p = 0.002). On multivariable analysis, only route of regional anesthesia was independently associated with reduced opioid use across all time points (24 h: mean difference = -5.75, 95% CI: -11.3, -0.18; 48 h: mean difference = -16.95, 95% CI: -27.5, -6.4; 72 h: mean difference = -20.39, 95% CI: -35.4, -5.3) Patient age, gender, race, obesity, neoadjuvant chemotherapy, small pancreatic duct, and pancreatic fistula were not independently associated with opioid use.
O-RA may offer a better approach than U-RA in minimizing opioid consumption after open PD. These findings suggest the incorporation of O-RA for upper abdominal surgeries to decrease the necessity of postoperative opioids.
阿片类药物危机是一个全国性问题，带来了巨大的经济负担，且与阿片类药物相关的死亡人数显著增加，尤其是在外科手术后。在围手术期，在维持有效镇痛的同时减少阿片类药物的需求量极具挑战性。多模式药物方案和引导式区域麻醉（RA）已被采用来解决这一问题。我们旨在根据RA给药途径评估接受开放性胰十二指肠切除术患者的术后阿片类药物消耗量：开放性与超声引导。
这项回顾性队列研究在埃默里大学圣约瑟夫医院进行，纳入了2020年至2022年接受开放性胰十二指肠切除术（PD）并接受超声引导RA（U-RA）或开放性RA（O-RA）的患者。分析了患者的人口统计学特征、手术细节和术后结果，包括在24、48和72小时以吗啡毫克当量（MME）衡量的阿片类药物消耗量。多变量线性回归确定了术后阿片类药物使用的预测因素。
95例患者中，47例符合纳入标准：27例接受U-RA，20例接受O-RA。接受O-RA和U-RA的患者术前和术中特征相似。在所有时间点，O-RA组的阿片类药物需求量均低于U-RA组。（24小时：6.5对18，p = 0.004；48小时：18对37，p = 0.001；72小时：30.5对57，p = 0.002）。在多变量分析中，只有区域麻醉途径在所有时间点均与阿片类药物使用减少独立相关（24小时：平均差异=-5.75，95%CI：-11.3，-0.18；48小时：平均差异=-16.95，95%CI：-27.5，-6.4；72小时：平均差异=-20.39，95%CI：-35.4，-5.3）。患者年龄、性别、种族、肥胖、新辅助化疗、小胰管和胰瘘与阿片类药物使用无独立相关性。
在开放性PD术后，O-RA在减少阿片类药物消耗方面可能比U-RA提供更好的方法。这些发现表明在腹部手术中采用O-RA以减少术后使用阿片类药物的必要性。
