Postoperative Opioid Use Decreases After Hospital Adopts Analgesia Care Bundle

A care bundle consisting of an individualized opioid regimen, regular gabapentinoids, and clonidine as a rescue analgesic was associated with a significant decrease in opioid consumption after major colorectal surgery, according to a study published online in JAMA Network Open.

“In the final year of the study, the proportion of patients receiving less than 45 morphine milligram equivalents (MME) orally or parenterally over the first 6 days after surgery was 66%, corresponding to 3 doses of oxycodone at 10 mg,” wrote corresponding author Mattias Soop, MD, PhD, of Karolinska University Hospital, Stockholm, Sweden, and study coauthors. “Furthermore, 31% received no opioids at all during the same period.”

The study included 842 patients who underwent major colorectal surgery between 2016 and 2019 at the 65-bed, university-affiliated Ersta Hospital in Stockholm, Sweden. Early in the study, the hospital introduced the multimodal analgesia care bundle to reduce reliance on opioid analgesia in the postoperative period.

Over the 4-year period, median opioid use decreased from 75 MME to 22 MME, and the proportion of patients receiving 45 MME or less rose from 35% to 66%, according to the study.

“These data demonstrate that the goal of nearly opioid-free major surgery is achievable in routine clinical practice, using alternative modalities to manage postoperative pain,” researchers wrote.

An individualized opioid regimen, the use of gabapentin, and increasing age were associated with less opioid consumption, multivariable analysis revealed. The use of clonidine as rescue analgesia was associated with more opioid consumption.

“This finding may indicate that patients who required clonidine also required additional doses of opioids, the second-line rescue analgesia when clonidine was used…” researchers wrote. “In the setting of our study, clonidine was used per request, which leads us to believe that it rather became a marker for an increase in pain.”

Reference

Gedda C, Nygren J, Garpenbeck A, Hoffström L, Thorell A, Soop M. Multimodal analgesia bundle and postoperative opioid use among patients undergoing colorectal surgery. JAMA Netw Open. 2023;6(9):e2332408. doi:10.1001/jamanetworkopen.2023.32408