Objective To examine the effect of anesthesia technique in an enhanced recovery after surgery (ERAS) pathway on post-operative opioid use.
Methods Patients undergoing open gynecologic surgery under an ERAS pathway from November 2014 through December 2018 were included retrospectively. All patients received pre-operative analgesia consisting of oral acetaminophen, pregabalin, celecoxib, and tramadol extended release, unless contraindicated. Patients received local wound infiltration with bupivacaine; the post-operative analgesic regimen was standardized. Patients were categorized by anesthesia technique: (1) inhalational, (2) total intravenous anesthesia (TIVA), and (3) combined technique. The primary outcome was post-operative opioid consumption measured as morphine equivalent dose, recorded as the total opioid dose received post-operatively, including doses received through post-operative day 3.
Results A total of 1184 patients underwent general anesthesia using either inhalational (386, 33%), TIVA (349, 29%), or combined (449, 38%) techniques. Patients who received combined anesthesia had longer surgery times (p=0.005) and surgical complexity was higher among patients who underwent TIVA (moderate/higher in 76 patients, 38%) compared with those who received inhaled anesthesia (intermediate/higher in 41 patients, 23%) or combined anesthesia (intermediate/higher in 72 patients, 30%). Patients who underwent TIVA anesthesia consumed less post-operative opioids than those managed with inhalational technique (0 (0–46.3) vs 10 (0–72.5), p=0.009) or combined anesthesia (0 (0–46.3) vs 10 (0–87.5), p=0.029). Similarly, patients who underwent the combined technique had similar opioid consumption post-operatively compared with those who received inhalational anesthesia (10 (0–87.5) vs 10 (0–72.5), p=0.34).
Conclusions TIVA technique is associated with a decrease in post-operative consumption of opioids after open gynecologic surgery in patients on an ERAS pathway.
- postoperative period
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Contributors JL: This author helped in manuscript preparation and led the study. MDI: This author helped in database management and manuscript preparation. GM: This author helped in manuscript preparation and editing. JC: This author helped in manuscript preparation and data interpretation. BP: This author helped in data analysis and manuscript preparation. WW: This author helped in manuscript preparation. AZV: This author helped in manuscript preparation and editing. KC: This author helped in manuscript preparation and data analysis. MB: This author helped in data collection and database management. TS: This author helped in data collection and database management. LAM: This author helped in manuscript preparation. PTR: This author helped in manuscript preparation, editing, and data analysis.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement De-identified data are available upon reasonable request.