Retrospective analysis of the impact on adult patients undergoing robotic colorectal surgery that receive opioid-free anesthesia compared to opioid-based anesthesia: An examination of effects on length of stay

[Audio] This study provides a retrospective analysis to examine the effects of opioid-free anesthesia compared to opioid-based anesthesia on length of stay for adult patients undergoing robotic colorectal surgery. It examines if opioid-free anesthesia has an impact on the length of stay for these patients. Data was gathered from multiple hospitals for a two-year period. The results of this study offer insights into the best options for anesthesia when performing robotic colorectal surgery..

[Audio] This presentation will focus on the effects of opioid-free anesthesia versus opioid-based anesthesia on length of stay for adult patients undergoing robotic colorectal surgery. I will start by introducing why this topic is important. Subsequently, I will go over the systematic review of current literature and the implementation of the opioid-free anesthesia protocol. After that, I will outline the findings from my DNP project and provide a summary of my results. Once I have finished the presentation, I will be available to answer any questions about the project and the results..

[Audio] Recent years have seen a significant impact on our society due to over-aggressive prescribing of opioids. The Joint Commission's declaration of pain as the fifth vital sign has been cited as a contributing factor to the opioid misuse epidemic. As a result, it has become increasingly important to manage opioid exposure safely for adult patients undergoing surgery, particularly with the rise of robotic colorectal surgery. This study examines the effects of opioid-free anesthesia versus opioid-based anesthesia on a patient's length of stay. Obtaining data from this research is critical to improving patient safety and addressing the social, political, and economic consequences associated with opioid exposure. Anesthesia providers have a vital role in selecting the type of analgesic administered during surgery and a combined approach is necessary to assess opioid exposure appropriately. This study will provide the necessary information to support clinical decisions during the surgical process, and help to provide the safest care possible..

[Audio] This study examines the impact that opioid-free anesthesia has on the length of stay for adult colorectal surgery patients, compared to opioid-based anesthesia. Social concerns have arisen due to opioid overprescribing, such as an increased risk for substance abuse and addiction. Policymakers are attempting to reduce the rate of overprescribing and improve access to addiction treatments. Long-term opioid use is a postoperative complication that has both medical and economic implications. ORADEs, or opioid-related adverse drug events, can significantly raise hospital costs. It has been found that 7% of surgery patients use prescription opioids long-term, increasing the need for treatments and cost mitigation strategies..

[Audio] ERAS protocols prioritize opioid-free approaches in order to reduce opioid requirements and adverse effects. Benefits of this shift include lower oral morphine equivalents, shorter hospital stays, and lower readmission rates. To ensure optimal care, a multidisciplinary team that includes anesthesia providers should be employed. Opioid-free anesthesia and multimodal adjuvants, such as nerve blocks and topical anesthetics, have been demonstrated to be particularly beneficial to vulnerable patient populations. Evidence suggests that implementing opioid-free anesthesia protocols leads to safer, more effective postoperative pain management..

What is pain?. Understanding Pain and Nociception Clarifying the concepts of pain and nociception: Pain is the conscious experience of noxious stimuli. Nociception is the transmission of pain signals regardless of consciousness. Components of the pain pathway: transduction, transmission, modulation, perception. Endogenous Ligands and Pain Signal Propagation Contribution of ligands to the propagation and modulation of pain signals and perception: The following endogenous ligands propagate pain signals (hyperalgesia): Prostaglandins, leukotrienes, glutamate, sodium ions, capsaicin, and cytoplasmic calcium The following e ndogenous ligands modulate pain signals (analgesia): endogenous opioids (Enkephalins and Endorphins), Anandamide and 2-Arachidonoylglycerol (2-AG), Adenosine, Gamma-Aminobutyric Acid (GABA) and Serotonin (5-HT) Dynorphins interact with opioid receptors, with a complex role in pain modulation. Depending on receptor type and release context, They can be pain-relieving (analgesia) and pain-sensitizing (hyperalgesia). Norepinephrine also plays a dual role in pain: inhibiting pain signals by binding to alpha-2 receptors while also intensifying pain during stress and potentially amplifying emotional distress from pain..

[Audio] Perception of pain is a complicated and diverse activity. It begins with transduction, where physical or chemically induced stimuli are changed to electrical signals. These signals are then moved along the rear nerves to the dorsal horn in the spinal cord, which can intensify or reduce the signals. Afterwards, the impulses are sent to the brain cores for further processing, where the pain is felt first in the thalamus and is pinpointed in the sensory cortex. This entire process helps us to understand why opioid-free anesthesia and opioid-based anesthesia produce different effects on the duration of a stay in adult patients going through robotic colorectal surgery..

[Audio] In this presentation, I'm going to discuss opioid-free anesthesia and its effects on length of stay for adult patients undergoing robotic colorectal surgery. Specifically, I will focus on the use of non-opioid pain adjuncts in a multimodal approach. This multimodal approach looks at different receptors along the pain pathway and uses nerve blocks and oral and intravenous opioid-free analgesics for desensitization. It's crucial to use these drugs for central and peripheral desensitization in order to offer robust pain relief and improved patient care. Additionally, I will focus on mechanisms of action and strategies for offering optimal pain relief and enhancing perioperative experiences, as well as endogenous ligands and multimodal analgesics that shape advanced pain management. Ultimately, this comprehensive approach will enhance pain relief and perioperative experiences for these patients. To further understand the pharmacology involved, please refer to the appendix which provides a list of analgesics and their mechanisms of action..

[Audio] The aim of this presentation is to examine the effects of opioid-free anesthesia versus opioid-based anesthesia on length of stay for adult patients undergoing robotic colorectal surgery. To answer this question, a systematic review of the existing literature was conducted. A range of databases were searched, including PubMed, Google Scholar, Trip Database, CINAHL, clinicaltrials.gov, and SpringerOPEN. Several types of studies were included within the review, such as randomized controlled trials, cohort studies, systematic reviews, and non-randomized studies. These studies evaluated the impact of opioid-free vs. opioid-based anesthesia on postoperative length of stay, nausea, vomiting, and pain in adult laparoscopic surgery patients. The review found evidence to suggest that opioid-free anesthesia may improve outcomes in terms of length of stay, nausea, vomiting, and pain; however, further research is needed to confirm the findings..

[Audio] This slide presents the criteria required for systematic reviews in order to determine the effects of opioid-free anesthesia versus opioid-based anesthesia on length of stay for adult patients undergoing robotic colorectal surgery. For this systematic review, the inclusion criteria included full-text, published results, adult patients of more than eighteen years of age, and two or more opioid-free adjuncts, such as ketamine, precedex, lidocaine, magnesium, esmolol, and so on. The control group had to include opioids, the full-text had to be in English, the study must have been conducted within the last five years, and the quality of the study had to be high. On the other hand, the exclusion criteria included unpublished results, pediatric patients, expert opinions, commentary, non-English publication, non-laparoscopic surgery, and non-opioid control group..

[Audio] We employed a systematic review to evaluate the effects of opioid-free anesthesia versus opioid-based anesthesia on length of stay for adult patients undergoing robotic colorectal surgery. This comprehensive analysis involved searching numerous databases such as Medline and EMBASE for existing studies to review. An assessment of the quality of the studies was also conducted, examining aspects such as the study design, the sample size and the potential for bias..

[Audio] An investigation was conducted to evaluate the effects of opioid-free versus opioid-based anesthesia on length of stay for adult patients undergoing robotic colorectal surgery. Data was gathered from 24 articles and outcomes such as postoperative pain, nausea, vomiting, opioid consumption, and length of stay were measured. Propofol as the primary anesthetic gave the most desirable outcomes. Other agents were tested for central desensitization, which included Lidocaine, Ketamine, Dexmedetomidine, Magnesium, Glucocorticoids, NSAIDs, Gabapentinoids, β-Blockers, and Acetaminophen. Results suggest opioid-free anesthesia can be beneficial for adult patients undergoing robotic colorectal surgery. Further details can be found in Appendices B, C, and D..

[Audio] Our data analysis examined the effects of opioid-free anesthesia versus opioid-based anesthesia on the length of stay for adults undergoing robotic colorectal surgery. Substances included in the analysis were lidocaine, ketamine, dexmedetomidine, magnesium, glucocorticoids, non-steroidal anti-inflammatory drugs, gabapentinoids, beta-blockers, acetaminophen and agents for central desensitization. We are now conducting a more detailed examination of the results..

[Audio] A retrospective analysis was conducted to quantify the improvement of outcomes following the implementation of a gas-based opioid-free anesthesia protocol in September 2021 and later shifting to a total intravenous opioid-free anesthesia protocol in May 2023 for adult patients undergoing robotic colorectal surgery. Results showed this protocol was successful in improving patient experience and outcomes. This study has potential to help other healthcare providers turn evidence into action..

[Audio] This project seeks to compare the effects of opioid-free anesthesia and opioid-based anesthesia on length of stay of adult patients undergoing robotic colorectal surgery. We plan to retrospectively analyze 21-23 adults to assess postoperative length of stay under opioid-free anesthesia. It requires the collaboration of the IRB, robotics specialist, department leads, and university faculty to collect and present data to key stakeholders. Success will be measured by a decrease in hospital stay and associated costs. If successful, this project will have a positive impact on patient outcomes, costs, and patient recovery experience..

[Audio] This study examines how opioid-free anesthesia compares to opioid-based anesthesia in regards to length of stay for adult patients undergoing robotic colorectal surgery. A retrospective analysis was conducted over three periods in order to compare the difference in length of stay before and after the introduction of opioid-free anesthesia. Inclusions and exclusions criteria were formulated such as adult patients undergoing robotic colorectal surgery and those exposed to opioids during opioid-free anesthesia. The goal of the study was to look at the efficacy of opioid-free anesthesia and the objectives were to identify resources, establish a data collection and analysis plan, and devise a data presentation strategy. To achieve these objectives, collaboration was needed with the multidisciplinary team, Internal Review Board, specialists, department leads, and university faculty..

[Audio] This research seeks to understand the effects of opioid-free versus opioid-based anesthesia on length of stay for adult patients having robotic colorectal surgery. Length of stay is a crucial measuring tool for evaluating the success of a surgical procedure, as well as having a direct economic impact. For example, laparoscopic robotic colorectal surgery with a two-day reduced length of stay can result in a cost savings of nearly $7,218 per patient. Furthermore, reduced length of stay is associated with other benefits, such as a decrease in the risk of infection, minimized medication side effects, faster recovery, and improved use of resources. The project will review data generated between 2021 and 2023 to compare pre-implementation baseline data to post-protocol implementation results through a retrospective analysis. Through this study, it is hoped to gain a better insight into the effects of opioid-free anesthesia on length of stay in comparison to opioid-based anesthesia..

[Audio] I am presenting a study examining the effects of opioid-free anesthesia versus opioid-based anesthesia on the length of hospital stay for adult patients undergoing robotic colorectal surgery. The use of opioid-based anesthetics is correlated to increased risks for patient safety, longer recovery time and higher costs for the healthcare system. In order to make the switch to opioid-free anesthesia successful, it is necessary to leverage the Prosci ADKAR Model for individual change transition. Making the desired patient outcomes a part of the service lines culture is also essential. Educating stakeholders about how opioid-free anesthesia affects these outcomes is imperative, and it will be necessary to monitor and report patient outcomes regularly for sustainable success in the transition..

[Audio] The research into opioid-free anesthesia as an alternative to opioid-based anesthesia in adult patients undergoing robotic colorectal surgery has demonstrated that it is associated with enhanced patient comfort and early recovery, as well as a positive impact on the opioid epidemic. It has been suggested that this protocol could be adapted to other surgical service lines, such as chronic pain, respiratory issues, obstructive sleep apnea, severe PONV history, substance use disorder recovery and potentially even cancer surgery and lung transplants. This could result in cost savings, safety and satisfaction. It is through retrospective data that interested parties are able to work with anesthesia members to tailor anesthetic plans that can be shared through service-wide channels such as grand rounds and newsletters. Doing so will help to ensure that patients are receiving the most appropriate and effective treatments available..

[Audio] I am presenting a retrospective analysis of patient outcomes comparing opioid-free anesthesia versus opioid-based anesthesia for laparoscopic surgeries. The results from this analysis are extremely promising in terms of optimizing patient experiences and benefitting all stakeholders. This revolutionary approach holds potential to reshape pain management practices not only in colorectal surgery, but also other laparoscopic surgeries, by reducing opioid-related complications. Going forward, these findings will help pave the way for further high-level studies such as randomized control trials. If validated, opioid-free anesthesia can become a safe alternative to opioid-based practices. This research is an important step in our journey of embracing a paradigm shift which can improve the care of our patients and benefit healthcare systems. Thank you for listening and I look forward to your questions..