Continuous Wound Irrigation and Intraoperative Methadone Decreases Opioid Use and Shortens Length of Stay After CRS/HIPEC

• Published in: Annals of surgical oncology Vol. 31; no. 6; pp. 3742 - 3749
• Main Authors: Boesl, Markus A., Brown, Noah, Bleicher, Josh, Call, Tyler, Lambert, Donald H., Lambert, Laura A.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.06.2024; Springer Nature B.V
• Subjects: Aged; Analgesia; Analgesia, Epidural - methods; Analgesics; Analgesics, Opioid - administration & dosage; Chemotherapy; Combined Modality Therapy; Cytoreduction Surgical Procedures - adverse effects; Epidural; Female; Follow-Up Studies; Humans; Hyperthermia, Induced - adverse effects; Intraoperative Care; Length of stay; Length of Stay - statistics & numerical data; Male; Medicine; Medicine & Public Health; Methadone; Methadone - administration & dosage; Methadone - therapeutic use; Middle Aged; Morphine; Multivariate analysis; Narcotics; Oncology; Opioids; Pain perception; Pain, Postoperative - drug therapy; Patients; Peritoneal Surface Malignancy; Prognosis; Resource utilization; Retrospective Studies; Surgery; Surgical Oncology; Therapeutic Irrigation - methods; Wounds
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-024-14900-1

Background Epidural analgesia is resource and labor intense and may limit postoperative management options and delay discharge. This study compared postoperative outcomes after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) with epidural analgesia versus continuous wound infusion system (CWIS) with/without intraoperative methadone. Methods A single-institution, retrospective chart review was performed including all patients undergoing open CRS/HIPEC from 2018 to 2021. Patient demographics, surgical characteristics, length of stay, and in-hospital analgesic use were reviewed. In-hospital opioid exposure in morphine milligram equivalents (MME) was calculated. Multivariate analysis (MVA) for mean total and daily opioid exposure was conducted. Results A total of 157 patients were included. Fifty-three (34%) had epidural analgesia, 96 (61%) had CWIS, and 79 (50%) received methadone. Length of stay was significantly shorter with CWIS + methadone versus epidural (7 vs. 8 days, p  < 0.01). MVA showed significantly lower mean total and daily opioid exposure with CWIS+methadone versus epidural (total: 252.8 ± 17.7 MME vs. 486.8 ± 86.6 MME; odds ratio [OR] 0.72, 95% confidence interval [CI] 0.52–0.98, p  = 0.04; Daily: 32.8 ± 2.0 MME vs. 51.9 ± 5.7 MME, OR 0.72, 95% CI 0.52–0.99, p  ≤ 0.05). The CWIS-only group ( n  = 17) had a significantly lower median oral opioid exposure versus epidural (135 MME vs. 7.5 MME, p  < 0.001) and longer length of stay versus CWIS + methadone (9 vs. 7 days, p  = 0.04), There were no CWIS or methadone-associated complications and one epidural abscess. Conclusions CWIS + methadone safely offers better pain control with less in-hospital opioid use, shorter length of stay, and decreased resource utilization compared with epidural analgesia in patients undergoing CRS-HIPEC.