Transfascial sutures and prior chronic opioid use were associated with higher opioid doses in a cohort of patients who underwent abdominal wall reconstruction, according to recent data.
The researchers evaluated 93 consecutive patients to assess potential determining factors associated with narcotic requirements. Some of the factors analyzed included those in the pre-operative setting, such as chronic preoperative narcotic usage, indication for abdominal wall reconstruction and administration of neuraxial analgesia; intraoperative factors, such as intraoperative narcotics administered and method of mesh; and postoperative factors, such as multimodal analgesia and complications.
Daily opioid amounts and length of hospital stay were the primary outcome measures.
Lower doses of postoperative opioid use were reported in patients who received an epidural, according to the findings. Higher doses were reported among patients who chronically used opioids before the operation, those whose mesh was fixated with transfascial sutures, and patients treated with high doses intraoperatively.
Patients in the transfascial suture mesh group experienced longer hospital stays, as did patients who received chronic opioids preoperatively.
“Intraoperative administration of opioids should be minimized to avoid the development of tolerance,” the researchers concluded. “Epidural analgesia reduces postoperative narcotic requirement and may be especially beneficial in patients at highest risk for postoperative pain.” – by Rob Volansky
Disclosure: One researcher reports being a consultant for LifeCell, Bard, and Daiichi Sankyo; receiving honoraria from Pacira and KCI; and receiving royalties from Thieme