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Korean J Anesthesiol. 2019 Nov 5. doi: 10.4097/kja.19370. [Epub ahead of print]

Association of trainee involvement in an acute pain service with postoperative opioid use in patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.

Author information

1
Department of Anesthesiology, Division of Regional Anesthesia and Acute Pain, University of California, San Diego, La Jolla, CA, USA.
2
Department of Medicine, Division of Biomedical Informatics, University of California, San Diego, La Jolla, CA, USA.

Abstract

Background:

Several hospitals have implemented a multidisciplinary Acute Pain Service (APS) to execute surgery-specific opioid sparing analgesic pathways. Implementation of an anesthesia attending-only APS has been associated with decreased postoperative opioid consumption, time to ambulation and time to solid food intake for patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.

Methods:

We performed a retrospective propensity-matched cohort study where we compared opioid consumption and hospital length of stay among two historical cohorts: attending-only service versus service involving a regional anesthesia fellow.

Results:

In the matched cohorts, the median postoperative day (POD) 0-3 opioid use [25%, 75% quartile] for the single attending and trainee involvement cohort were 38.5 mg MEQ [14.1 mg, 106.3 mg] and 50.4 mg MEQ [28.4 mg, 91.2 mg], respectively. The median difference was -9.8 mg MEQ (95% CI- 30.7-16.5 mg, P = 0.43).

Conclusions:

We found that the addition of a regional anesthesia fellow to the APS team was not associated with statistically significant differences in total opioid consumption or hospital length of stay in this surgical population. The addition of trainees to the infrastructure, with vigilant supervision, is not associated with change in outcomes.

KEYWORDS:

Acute pain service, Epidural; Opioids; Trainee

PMID:
31684716
DOI:
10.4097/kja.19370
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