The effect of anesthesia choice on post-operative outcomes in women undergoing exploratory laparotomy for a suspected gynecologic malignancy

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Abstract

Objective To determine how anesthesia choice in women undergoing laparotomy for gynecologic malignancy affects pain control and narcotic use. Methods This is a retrospective study of women who underwent laparotomy for suspected gynecologic malignancy from May 2012 to January 2013. Patients were categorized into one of three groups: 1) patient controlled analgesia (PCA); 2) PCA + transversus abdominis plane block (TAP); and 3) patient-controlled epidural analgesia (PCEA). Mean narcotic use and patient reported pain scores were compared. Results The analysis includes 112 women (44 PCA, 30 TAP, 38 PCEA). Intraoperative factors were not different between groups with the exception of a significant difference in the rate of intra-operative complications (p = 0.020), with lower rates in the PCEA group. The groups differed in intravenous narcotic use in each of the first three postoperative days (day 0: p = 0.014; day 1: p < 0.0001; day 2: p = 0.048), with patients in the TAP group using the least on day 0 and those in the PCEA group using less on postoperative days 1 and 2. In addition, the PCEA group reported lower pain scores on postoperative days 1 and 2 (day 1: p = 0.046; day 2: p = 0.008). Conclusions The use of patient controlled epidural anesthesia after laparotomy for gynecologic malignancy is associated with decreased IV and PO narcotic use and improved pain control without increasing complications or length of hospital stay. Further investigation with prospective randomized trials is warranted to elucidate the optimal post-operative pain management technique.

Original languageEnglish (US)
Pages (from-to)278-282
Number of pages5
JournalGynecologic oncology
Volume133
Issue number2
DOIs
StatePublished - May 2014

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Patient-Controlled Analgesia
Laparotomy
Anesthesia
Epidural Analgesia
Abdominal Muscles
Neoplasms
Narcotics
Pain
Length of Stay
Epidural Anesthesia
Drug and Narcotic Control
Pain Management
Retrospective Studies

Keywords

  • Laparotomy
  • Pain control
  • Regional anesthesia
  • TAP blocks

Cite this

@article{8f7f5eac9b3a4e35915e2b94f2e0b0e2,
title = "The effect of anesthesia choice on post-operative outcomes in women undergoing exploratory laparotomy for a suspected gynecologic malignancy",
abstract = "Objective To determine how anesthesia choice in women undergoing laparotomy for gynecologic malignancy affects pain control and narcotic use. Methods This is a retrospective study of women who underwent laparotomy for suspected gynecologic malignancy from May 2012 to January 2013. Patients were categorized into one of three groups: 1) patient controlled analgesia (PCA); 2) PCA + transversus abdominis plane block (TAP); and 3) patient-controlled epidural analgesia (PCEA). Mean narcotic use and patient reported pain scores were compared. Results The analysis includes 112 women (44 PCA, 30 TAP, 38 PCEA). Intraoperative factors were not different between groups with the exception of a significant difference in the rate of intra-operative complications (p = 0.020), with lower rates in the PCEA group. The groups differed in intravenous narcotic use in each of the first three postoperative days (day 0: p = 0.014; day 1: p < 0.0001; day 2: p = 0.048), with patients in the TAP group using the least on day 0 and those in the PCEA group using less on postoperative days 1 and 2. In addition, the PCEA group reported lower pain scores on postoperative days 1 and 2 (day 1: p = 0.046; day 2: p = 0.008). Conclusions The use of patient controlled epidural anesthesia after laparotomy for gynecologic malignancy is associated with decreased IV and PO narcotic use and improved pain control without increasing complications or length of hospital stay. Further investigation with prospective randomized trials is warranted to elucidate the optimal post-operative pain management technique.",
keywords = "Laparotomy, Pain control, Regional anesthesia, TAP blocks",
author = "Colleen Rivard and Dickson, {Elizabeth L.} and Vogel, {Rachel Isaksson} and Argenta, {Peter A.} and Deanna Teoh",
year = "2014",
month = "5",
doi = "10.1016/j.ygyno.2014.02.027",
language = "English (US)",
volume = "133",
pages = "278--282",
journal = "Gynecologic Oncology",
issn = "0090-8258",
publisher = "Academic Press Inc.",
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T1 - The effect of anesthesia choice on post-operative outcomes in women undergoing exploratory laparotomy for a suspected gynecologic malignancy

AU - Rivard, Colleen

AU - Dickson, Elizabeth L.

AU - Vogel, Rachel Isaksson

AU - Argenta, Peter A.

AU - Teoh, Deanna

PY - 2014/5

Y1 - 2014/5

N2 - Objective To determine how anesthesia choice in women undergoing laparotomy for gynecologic malignancy affects pain control and narcotic use. Methods This is a retrospective study of women who underwent laparotomy for suspected gynecologic malignancy from May 2012 to January 2013. Patients were categorized into one of three groups: 1) patient controlled analgesia (PCA); 2) PCA + transversus abdominis plane block (TAP); and 3) patient-controlled epidural analgesia (PCEA). Mean narcotic use and patient reported pain scores were compared. Results The analysis includes 112 women (44 PCA, 30 TAP, 38 PCEA). Intraoperative factors were not different between groups with the exception of a significant difference in the rate of intra-operative complications (p = 0.020), with lower rates in the PCEA group. The groups differed in intravenous narcotic use in each of the first three postoperative days (day 0: p = 0.014; day 1: p < 0.0001; day 2: p = 0.048), with patients in the TAP group using the least on day 0 and those in the PCEA group using less on postoperative days 1 and 2. In addition, the PCEA group reported lower pain scores on postoperative days 1 and 2 (day 1: p = 0.046; day 2: p = 0.008). Conclusions The use of patient controlled epidural anesthesia after laparotomy for gynecologic malignancy is associated with decreased IV and PO narcotic use and improved pain control without increasing complications or length of hospital stay. Further investigation with prospective randomized trials is warranted to elucidate the optimal post-operative pain management technique.

AB - Objective To determine how anesthesia choice in women undergoing laparotomy for gynecologic malignancy affects pain control and narcotic use. Methods This is a retrospective study of women who underwent laparotomy for suspected gynecologic malignancy from May 2012 to January 2013. Patients were categorized into one of three groups: 1) patient controlled analgesia (PCA); 2) PCA + transversus abdominis plane block (TAP); and 3) patient-controlled epidural analgesia (PCEA). Mean narcotic use and patient reported pain scores were compared. Results The analysis includes 112 women (44 PCA, 30 TAP, 38 PCEA). Intraoperative factors were not different between groups with the exception of a significant difference in the rate of intra-operative complications (p = 0.020), with lower rates in the PCEA group. The groups differed in intravenous narcotic use in each of the first three postoperative days (day 0: p = 0.014; day 1: p < 0.0001; day 2: p = 0.048), with patients in the TAP group using the least on day 0 and those in the PCEA group using less on postoperative days 1 and 2. In addition, the PCEA group reported lower pain scores on postoperative days 1 and 2 (day 1: p = 0.046; day 2: p = 0.008). Conclusions The use of patient controlled epidural anesthesia after laparotomy for gynecologic malignancy is associated with decreased IV and PO narcotic use and improved pain control without increasing complications or length of hospital stay. Further investigation with prospective randomized trials is warranted to elucidate the optimal post-operative pain management technique.

KW - Laparotomy

KW - Pain control

KW - Regional anesthesia

KW - TAP blocks

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