Korean J Anesthesiol.  2020 Jun;73(3):219-223. 10.4097/kja.19370.

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

• Said ET
• Sztain JF
• Martin EI
• Abramson WB
• Meineke MN
• Furnish TJ
• Swisher MW
• Gabriel RA

• KMID: 2503125
• DOI: http://doi.org/10.4097/kja.19370

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. In this study, we evaluated the impact of introducing an APS trainee on postoperative opioid consumption in patients undergoing hyperthermic intraperitoneal chemotherapy during POD 0–3.
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 APS 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 morphine equivalents (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). There was no difference in hospital length of stay between both cohorts (P = 0.67).
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.

Keyword

Acute pain service; Epidural; Opioids; Trainee