Pre-emptive pain management program is associated with reduction of opioid prescription after minimally invasive pulmonary resection

Haydee Del Calvo, Duc T. Nguyen, Leonora M. Meisenbach, Ray Chihara, Edward Y. Chan, Edward A. Graviss, Min Peter Kim

Research output: Contribution to journalArticlepeer-review

Abstract

Background: We developed and implemented a pre-emptive pain management program wherein providers agreed to have non-opioid pain medication as a standard pain management strategy at discharge accompanied by patient education about the program. Methods: A retrospective case-control study of prospectively collected data of patients who underwent minimally invasive pulmonary resection. We compared the outcomes among patients who were managed with pre-emptive pain management program with enhanced recovery after surgery (Pre-emptive), enhanced recovery program after surgery alone (ERAS) and standard care (control). Results: Of the 443 patients, 132 patients (30%) were in the pre-emptive pain management group, 90 (20%) patients were in the ERAS only group and 221 (50%) in the control group. There were significantly fewer complications (15.9% vs. 23.3% vs. 38%, P<0.001), shorter median length of hospital stay (2 vs. 3 vs. 3 days, P<0.001), lower 30-day readmission rates (2.3% vs. 3.3% vs. 11.3%, P=0.002), and fewer opioid prescriptions at discharge (17.4% vs. 76.7% vs. 83.7%, P<0.001) in the pre-emptive pain management group compared to the ERAS and control groups. Multivariate logistic regression analyses showed that the preemptive pain management program (OR 0.06; 95% CI, 0.03, 0.11, P<0.001) and robotic surgery (OR 0.52; 95% CI, 0.3, 0.88, P=0.02) were associated with lower odds of patients being discharged to home with opioid prescriptions. The median pain score in the pre-emptive pain group at 30 days after surgery was 1.5 on a pain scale of 1-10. Conclusions: The pre-emptive pain management program was associated with a decrease in opioid prescriptions after elective pulmonary resections. Successful implementation of this program can lead to significant decreases in the amount of prescription opioids in the community.

Original languageEnglish (US)
Pages (from-to)1982-1990
Number of pages9
JournalJournal of Thoracic Disease
Volume12
Issue number5
DOIs
StatePublished - May 1 2020

Keywords

  • Enhanced recovery after surgery (ERAS)
  • Minimally invasive surgery
  • Opioid medication
  • Postoperative pain management
  • Robot assisted lung resection

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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