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Impact of anesthesia technique on post-operative opioid use in open gynecologic surgery in an enhanced recovery after surgery pathway
  1. Javier Lasala1,
  2. Gabriel E. Mena1,
  3. Maria D Iniesta2,
  4. Juan Cata1,
  5. Brandelyn Pitcher3,
  6. Williams Wendell1,
  7. Andrés Zorrilla-Vaca1,
  8. Katherine Cain4,
  9. Maria Basabe2,
  10. Tina Suki2,
  11. Larissa A Meyer2 and
  12. Pedro T Ramirez2
  1. 1Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  2. 2Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  3. 3Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  4. 4Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  1. Correspondence to Dr Javier Lasala, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; JLasala{at}mdanderson.org

Abstract

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.

  • anesthesia
  • general
  • postoperative period

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Footnotes

  • Twitter @gabemenaMD, @pedroramirezMD

  • 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.

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