Author: Erika Powers
A novel multimodal analgesia pathway was associated with decreased periprocedural opioid consumption for patients undergoing CT-guided percutaneous hepatic microwave ablation, according to a study presented at Anesthesiology 2021, the Annual Meeting of the American Society of Anesthesiologists (ASA).
“There is a growing need to manage acute periprocedural pain for patients undergoing procedures outside the operating room,” said Rudy Chen, MD, Massachusetts General Hospital, Boston, Massachusetts. “Enhanced recovery pathways are beneficial for surgical patients but are not yet standard in the procedural space.”
The researchers analysed outcomes of patients who received an Enhanced Recovery After Procedure (ERAP) protocol compared with those who did not. The study included data from 276 patients who underwent CT-guided percutaneous hepatic microwave ablation and received standard care (control group), pre-procedure analgesic, pre-procedure analgesic with unilateral paravertebral block, or pre-procedure analgesic with bilateral paravertebral block and unilateral paravertebral block.
Patients who received pre-procedure analgesic with unilateral paravertebral block received significantly less intra-procedure opioids than the control group (P< .001) and the pre-procedure analgesic alone group (P< .01). Patients who received pre-procedure analgesic with bilateral paravertebral block and unilateral paravertebral block also received significantly less intra-procedure opioids than the control group (P< .01).
There was a significant difference in post-procedure opioid use, reported in morphine equivalents, between patients who received pre-procedure analgesic with unilateral paravertebral block and the control group (3.82 mg vs 17.17 mg; P = .03).
“The near 4-fold decrease in intra-procedure and immediate post-procedure opioid consumption in patients who received pre-procedural analgesics and bilateral paravertebral blocks suggest that institutionalisation of a multimodal analgesic pathway is associated with decreased periprocedural opioid administration for CT-guided hepatic microwave ablation,” said Dr. Chen. “This study provides a basis to expand the use of multimodal analgesia outside of the operating room and to prospectively investigate its impact on opioid administration as well as other key outcomes including recovery time, patient satisfaction, and hospital admission rates.”