Opioid Sparing Pain Management Strategy

Overview

The purpose of this research study is to compare the amount of morphine milligram equivalents consumed post operatively until discharge between the control cohort and intervention cohort.

Full Title of Study: “A Multi-modal, Opioid Sparing Pain Management Strategy in Cardiac Surgery”

Study Type

  • Study Type: Observational
  • Study Design
    • Time Perspective: Retrospective
  • Study Primary Completion Date: April 30, 2019

Detailed Description

Retrospective data will be collected on patients admitted to Prisma Health-Upstate Greenville Memorial Hospital in the Cardiovascular Intensive Care Unit following cardiovascular surgery. They will be divided into two cohorts, a control cohort from September 1, 2018 – October 31, 2018 and an intervention cohort from March 1, 2019 – April 30, 2019. A study investigator will assess each participant's electronic medical record through the electronic medical record database – EPIC to determine eligibility per the protocol. Demographic information will be collected, including age, date of birth, race, sex, height, weight, and ethnicity. Extubation and reintubation status will be collected along with medical history, type of cardiovascular procedure, medications, length of stay, pain scores, complications, and labs.

Interventions

  • Other: Multi-modal Opioid Sparing Pain Management Protocol
    • Incorporating multimodal opioid sparing ERAS techniques for cardiac surgery patients should show a decrease in the amount of opioids received, reduction in incidence of chronic pain, ileus, delirium, and potential for opioid addiction post-operatively. Between the dates of November 2018 through February 2019, a multi-modal, opioid sparing pain management protocol was evolving and a protocol was put into place. This study will compare outcomes before and after implementation of the protocol between the dates of September 1, 2018 – October 31, 2018 and March 1, 2019 – April 30, 2019.

Arms, Groups and Cohorts

  • Control Cohort
    • A control cohort from September 1, 2018 – October 31, 2018
  • Intervention Cohort
    • An intervention cohort from March 1, 2019 – April 30, 2019

Clinical Trial Outcome Measures

Primary Measures

  • Morphine Milligram Equivalents Comparison
    • Time Frame: 1 year
    • Compare the amount of morphine milligram equivalents consumed post operatively until discharge between groups.

Secondary Measures

  • Pain Scores
    • Time Frame: 1 year
    • Compare pain scores upon hospital discharge between both cohorts.
  • Ileus
    • Time Frame: 1 year
    • Compare incidence of postoperative ileus between both cohorts.
  • Delirium
    • Time Frame: 1 year
    • Compare incidence of delirium between both cohorts.

Participating in This Clinical Trial

Inclusion Criteria

  • Adult patients 18 and over
  • Patients who underwent cardiac surgery requiring a coronary pulmonary bypass machine during September 1, 2018 – April 30, 2019

Exclusion Criteria

  • Patients being placed on Extracorporeal Membrane Oxygenation

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: Accepts Healthy Volunteers

Investigator Details

  • Lead Sponsor
    • Prisma Health-Upstate
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Caroline McKillop, MD, Principal Investigator, Prisma Health-Upstate

References

Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, Carter T, Cassidy CL, Chittenden EH, Degenhardt E, Griffith S, Manworren R, McCarberg B, Montgomery R, Murphy J, Perkal MF, Suresh S, Sluka K, Strassels S, Thirlby R, Viscusi E, Walco GA, Warner L, Weisman SJ, Wu CL. Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016 Feb;17(2):131-57. doi: 10.1016/j.jpain.2015.12.008. Erratum in: J Pain. 2016 Apr;17(4):508-10. Dosage error in article text.

Devlin JW, Skrobik Y, Gélinas C, Needham DM, Slooter AJC, Pandharipande PP, Watson PL, Weinhouse GL, Nunnally ME, Rochwerg B, Balas MC, van den Boogaard M, Bosma KJ, Brummel NE, Chanques G, Denehy L, Drouot X, Fraser GL, Harris JE, Joffe AM, Kho ME, Kress JP, Lanphere JA, McKinley S, Neufeld KJ, Pisani MA, Payen JF, Pun BT, Puntillo KA, Riker RR, Robinson BRH, Shehabi Y, Szumita PM, Winkelman C, Centofanti JE, Price C, Nikayin S, Misak CJ, Flood PD, Kiedrowski K, Alhazzani W. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med. 2018 Sep;46(9):e825-e873. doi: 10.1097/CCM.0000000000003299.

Li M, Zhang J, Gan TJ, Qin G, Wang L, Zhu M, Zhang Z, Pan Y, Ye Z, Zhang F, Chen X, Lin G, Huang L, Luo W, Guo Q, Wang E. Enhanced recovery after surgery pathway for patients undergoing cardiac surgery: a randomized clinical trial. Eur J Cardiothorac Surg. 2018 Sep 1;54(3):491-497. doi: 10.1093/ejcts/ezy100.

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