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Predictors of Post-operative Pain and Opioid Consumption in Patients Undergoing Liver Surgery

  • R. Behman
  • S. Cleary
  • P. McHardy
  • A. Kiss
  • J. Sawyer
  • S. S. J. Ladak
  • S. A. McCluskey
  • C. Srinivas
  • J. Katz
  • N. Coburn
  • C. Law
  • A. C. Wei
  • P. Greig
  • J. Hallet
  • H. Clarke
  • P. J. KaranicolasEmail author
Original Scientific Report

Abstract

Background

Post-operative pain management is a critical component of perioperative care. Patients at risk of poorly controlled post-operative pain may benefit from early measures to optimize pain management. We sought to identify risk factors for post-operative pain and opioid consumption in patients undergoing liver resection.

Methods

This is a multi-institutional prospective nested cohort study of patients undergoing open liver resection. Opioid consumption and pain scores were collected following surgery. To estimate the effects of patient factors on opioid consumption (oral morphine equivalents—OME) and on pain scores (NRS-11), we used generalized linear models and multivariable linear regression model, respectively.

Results

One hundred and fifty-three patients who underwent open liver resection between 2013 and 2016 were included in the study. The mean patient age was 62.2 years, and 43.3% were female. Younger patients were significantly more likely to use more opioids in the early post-operative period (16.7 OME/10 years, p < 0.001). Patient factors that were significantly associated with increased NRS-11 pain scores also included younger patient age (difference in pain score of 0.3/10 years with cough and 0.2/10 years at rest, p < 0.01 for both) as well as a history of analgesic use (difference in pain score of 0.9 with cough and 0.6 at rest, p < 0.01 and p = 0.07, respectively).

Conclusion

Younger patients and those with a history of analgesic use are more likely to report higher post-operative pain and require higher doses of opioids. Early identification of these patients, and measures to better manage their pain, may contribute to optimal perioperative care.

Notes

Acknowledgements

Support for the randomized controlled trial of MOTAP catheter analgesia, the data from which were used for this study, was provided by the Innovation Fund of the Alternative Funding Plan from the Academic Health Sciences Centres of Ontario. Dr. Karanicolas is supported by a Canadian Institute of Health Research (CIHR) New Investigator Award. Dr. Clarke is supported by a University of Toronto, Department of Anesthesia Research Merit Award.

Funding

Funding for the randomized controlled trial from which data were used in this nested cohort study was provided by the Academic Health Science Centre (AHSC) Alternative Funding Plan (AFP) Innovation Grant

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    McMahon AJ, Russell IT, Ramsay G et al (1994) Laparoscopic and minilaparotomy cholecystectomy: a randomized trial comparing postoperative pain and pulmonary function. Surgery 115(5):533–539Google Scholar
  2. 2.
    Ballantyne JC, Carr DB, deFerranti S et al (1998) The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials. Anesth Analg 86(3):598–612CrossRefGoogle Scholar
  3. 3.
    Beattie WS, Badner NH, Choi P (2001) Epidural analgesia reduces postoperative myocardial infarction: a meta-analysis. Anesth Analg 93(4):853–858CrossRefGoogle Scholar
  4. 4.
    Morrison RS, Magaziner J, McLaughlin MA et al (2003) The impact of post-operative pain on outcomes following hip fracture. Pain 103(3):303–311CrossRefGoogle Scholar
  5. 5.
    Thiels CA, Anderson SS, Ubl DS et al (2017) Wide variation and overprescription of opioids after elective surgery. Ann Surg 266(4):564–573.  https://doi.org/10.1097/SLA.0000000000002365 CrossRefGoogle Scholar
  6. 6.
    Sun EC, Darnall BD, Baker LC, Mackey S (2016) Incidence of and risk factors for chronic opioid use among opioid-naive patients in the postoperative period. JAMA Intern Med 176(9):1286–1293.  https://doi.org/10.1001/jamainternmed.2016.3298 CrossRefGoogle Scholar
  7. 7.
    Waljee JF, Li L, Brummett CM, Englesbe MJ (2017) Iatrogenic opioid dependence in the united states: are surgeons the gatekeepers? Ann Surg 265(4):728–730.  https://doi.org/10.1097/SLA.0000000000001904 CrossRefGoogle Scholar
  8. 8.
    Daoust R, Paquet J, Moore L et al (2017) Incidence and risk factors of long-term opioid use in elderly trauma patients. Ann Surg.  https://doi.org/10.1097/sla.0000000000002461 Google Scholar
  9. 9.
    Sekhri S, Arora NS, Cottrell H et al (2017) Probability of opioid prescription refilling after surgery: does initial prescription dose matter? Ann Surg.  https://doi.org/10.1097/sla.0000000000002308 Google Scholar
  10. 10.
    Hill MV, Stucke RS, McMahon ML, Beeman JL, Barth RJ (2017) An educational intervention decreases opioid prescribing after general surgical operations. Ann Surg 1:1.  https://doi.org/10.1097/sla.0000000000002198 Google Scholar
  11. 11.
    Behman R, McHardy P, Sawyer J, Lam-McCulloch J, Karanicolas PJ (2014) Medial open transversus abdominal plane catheter analgesia: a simple, safe, effective technique after open liver resection. J Am Coll Surg 218(5):e91–e94.  https://doi.org/10.1016/j.jamcollsurg.2013.12.054 CrossRefGoogle Scholar
  12. 12.
    Karanicolas P, Cleary S, McHardy P et al (2014) Medial open transversus abdominis plane (MOTAP) catheters for analgesia following open liver resection: study protocol for a randomized controlled trial. Trials 15(1):241.  https://doi.org/10.1186/1745-6215-15-241 CrossRefGoogle Scholar
  13. 13.
    Kennedy-Hendricks A, Gielen A, McDonald E, McGinty EE, Shields W, Barry CL (2016) Medication sharing, storage, and disposal practices for opioid medications among US adults. JAMA Intern Med 176(7):1027–1029.  https://doi.org/10.1001/jamainternmed.2016.2543 CrossRefGoogle Scholar
  14. 14.
    Macintyre PE, Jarvis DA (1996) Age is the best predictor of postoperative morphine requirements. Pain 64(2):357–364CrossRefGoogle Scholar
  15. 15.
    Thomas T, Robinson C, Champion D, McKell M, Pell M (1998) Prediction and assessment of the severity of post-operative pain and of satisfaction with management. Pain 75(2–3):177–185CrossRefGoogle Scholar
  16. 16.
    Glasson JC, Sawyer WT, Lindley CM, Ginsberg B (2002) Patient-specific factors affecting patient-controlled analgesia dosing. J Pain Palliat Care Pharmacother 16(2):5–21CrossRefGoogle Scholar
  17. 17.
    Chang K-Y, Tsou M-Y, Chan K-H, Sung C-S, Chang W-K (2006) Factors affecting patient-controlled analgesia requirements. J Formos Med Assoc 105(11):918–925.  https://doi.org/10.1016/S0929-6646(09)60177-7 CrossRefGoogle Scholar
  18. 18.
    Kulkarni AR, Pusic AL, Hamill JB et al (2017) Factors associated with acute postoperative pain following breast reconstruction. JPRAS Open 11:1–13.  https://doi.org/10.1016/j.jpra.2016.08.005 CrossRefGoogle Scholar
  19. 19.
    Bohnert ASB, Valenstein M, Bair MJ et al (2011) Association between opioid prescribing patterns and opioid overdose-related deaths. JAMA 305(13):1315–1321.  https://doi.org/10.1001/jama.2011.370 CrossRefGoogle Scholar
  20. 20.
    Shah A, Hayes CJ, Martin BC (2017) Characteristics of initial prescription episodes and likelihood of long-term opioid use—United States, 2006–2015. MMWR Morb Mortal Wkly Rep 66(10):265–269.  https://doi.org/10.15585/mmwr.mm6610a1 CrossRefGoogle Scholar
  21. 21.
    Katz J, Seltzer Z (2009) Transition from acute to chronic postsurgical pain: risk factors and protective factors. Expert Rev Neurother 9(5):723–744.  https://doi.org/10.1586/ern.09.20 CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • R. Behman
    • 1
  • S. Cleary
    • 2
    • 7
  • P. McHardy
    • 3
  • A. Kiss
    • 4
  • J. Sawyer
    • 3
  • S. S. J. Ladak
    • 5
  • S. A. McCluskey
    • 6
  • C. Srinivas
    • 6
  • J. Katz
    • 5
    • 6
  • N. Coburn
    • 1
    • 4
  • C. Law
    • 1
    • 4
  • A. C. Wei
    • 2
  • P. Greig
    • 2
  • J. Hallet
    • 1
  • H. Clarke
    • 5
    • 6
  • P. J. Karanicolas
    • 1
    • 4
    Email author
  1. 1.Department of Surgery, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoCanada
  2. 2.Department of Surgery, University Health NetworkUniversity of TorontoTorontoCanada
  3. 3.Department of Anaesthesia, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoCanada
  4. 4.Department of Health Policy, Management, and EvaluationUniversity of TorontoTorontoCanada
  5. 5.Department of Anaesthesia and Pain Management, University Health NetworkUniversity of TorontoTorontoCanada
  6. 6.Pain Research Unit, Toronto General HospitalUniversity Health NetworkTorontoCanada
  7. 7.Division of Hepatobiliary and Pancreas SurgeryMayo ClinicRochesterUSA

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