Impact of a multidisciplinary multimodal opioid minimization initiative in kidney transplant recipients

Opioid use after kidney transplant has been shown to be a risk factor for chronic opioid use, which leads to an increased risk of mortality. The purpose of this study was to evaluate the early impact of a multimodal pain regimen and education quality improvement program on opioid use after kidney transplant 2 months after implementation. This was a retrospective, single‐center analysis of post‐operative opioid use, comparing the average daily Morphine milligram equivalents (MME) of the patients who received education on opioids and a multimodal pain regimen (preoperative TAP/QL block, scheduled APAP and gabapentin) compared to a historical control group. Despite having no differences in pre‐transplant opioid exposure, daily and overall inpatient opioid utilization was significantly reduced in the multimodal pain protocol cohort (38.6 vs 8.0 MME/day; P < .001); 5% of patients in the multimodal pain protocol cohort were discharged with an opioid prescription, compared to 96% of controls (P < .001). Our early results demonstrate that a multimodal pain protocol can effectively and dramatically reduce short‐term opioid utilization in kidney transplant recipients.

[1]  Y. Wen,et al.  Ultrasound guided continuous Quadratus Lumborum block hastened recovery in patients undergoing open liver resection: a randomized controlled, open-label trial , 2019, BMC Anesthesiology.

[2]  A. Hutson,et al.  Ultrarestrictive Opioid Prescription Protocol for Pain Management After Gynecologic and Abdominal Surgery , 2018, JAMA network open.

[3]  B. Kasiske,et al.  Prescription opioid use before and after kidney transplant: Implications for posttransplant outcomes , 2018, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[4]  N. Gnanasekar,et al.  A Comparative Study of Transversus Abdominis Plane Block versus Quadratus Lumborum Block for Postoperative Analgesia following Lower Abdominal Surgeries: A Prospective Double-blinded Study , 2018, Anesthesia Essays and Researches.

[5]  P. Kimmel,et al.  Opioid Prescription, Morbidity, and Mortality in US Transplant Recipients , 2018, Transplantation.

[6]  Lawrence Scholl,et al.  Overdose deaths involving opioids, cocaine, and psychostimulants — United States, 2015–2016 , 2018, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[7]  R. Barth,et al.  An Educational Intervention Decreases Opioid Prescribing After General Surgical Operations , 2017, Annals of surgery.

[8]  Stephanie E. Moser,et al.  New Persistent Opioid Use After Minor and Major Surgical Procedures in US Adults , 2017, JAMA surgery.

[9]  R. Barth,et al.  Wide Variation and Excessive Dosage of Opioid Prescriptions for Common General Surgical Procedures , 2017, Annals of surgery.

[10]  Feijun Luo,et al.  The Economic Burden of Prescription Opioid Overdose, Abuse, and Dependence in the United States, 2013 , 2016, Medical care.

[11]  R. Blanco,et al.  Quadratus lumborum block for postoperative pain after caesarean section: A randomised controlled trial , 2015, European journal of anaesthesiology.

[12]  P. Modi,et al.  The analgesic efficacy of continuous transversus abdominis plane block in renal transplant recipients , 2015, Journal of anaesthesiology, clinical pharmacology.

[13]  M. Schnitzler,et al.  Associations of Pre-Transplant Prescription Narcotic Use with Clinical Complications after Kidney Transplantation , 2015, American Journal of Nephrology.

[14]  J. Dalton,et al.  Continuous transversus abdominis plane block catheter analgesia for postoperative pain control in renal transplant , 2015, Journal of Anesthesia.

[15]  S. Hedden,et al.  Substance Use and Mental Health Estimates from the 2013 National Survey on Drug Use and Health: Overview of Findings , 2014 .

[16]  F. Luan,et al.  Chronic opioid analgesic usage post‐kidney transplantation and clinical outcomes , 2014, Clinical transplantation.

[17]  G. Shoeibi,et al.  Efficacy of transversus abdominis plane block for acute postoperative pain relief in kidney recipients: a double-blinded clinical trial. , 2014, Pain medicine.

[18]  F. Luan,et al.  A history of chronic opioid usage prior to kidney transplantation may be associated with increased mortality risk. , 2013, Kidney international.

[19]  A. Cunningham,et al.  Transversus Abdominis Plane Block for Analgesia in Renal Transplantation: A Randomized Controlled Trial , 2012, Anesthesia and analgesia.

[20]  F. Ziade,et al.  Preoperative vs. Postoperative Bilateral Paravertebral Blocks for Laparoscopic Cholecystectomy: A Prospective Randomized Clinical Trial , 2011, Pain practice : the official journal of World Institute of Pain.

[21]  S. Pollard,et al.  Continuous transversus abdominis plane block for renal transplant recipients. , 2009, Anesthesia and analgesia.