{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T03:48:41Z","timestamp":1752551321714,"version":"3.41.0"},"reference-count":49,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,1,8]],"date-time":"2025-01-08T00:00:00Z","timestamp":1736294400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Opioid crisis is a national issue with significant economic burden and marked increase in opioid\u2010related deaths, particularly following surgical procedures. Reducing opioid requirements while maintaining effective analgesia is critically challenging, perioperatively. Multimodal drug regimens and guided regional anesthesia (RA) have been adopted to address this issue. We aimed to assess postoperative opioid consumption in patients undergoing open pancreatoduodenectomy based on the routes of RA administration: open versus ultra\u2010sound guided.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective cohort study was conducted at Emory University Saint Joseph's Hospital, encompassing patients who underwent open pancreatoduodenectomy (PD) from 2020 to 2022 who received ultrasound\u2010guided RA (U\u2010RA) or open RA (O\u2010RA). Patient demographics, surgical details, and postoperative outcomes, including opioid consumption measured in morphine milligram equivalents (MME) at 24, 48, and 72 h, were analyzed. Multivariable linear regression identified predictors of postoperative opioid use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 95 patients, 47 met inclusion criteria: 27 received U\u2010RA and 20 O\u2010RA. Preoperative and intraoperative characteristics were similar between patients receiving O\u2010RA and U\u2010RA. A lower opioid requirement was noted in the O\u2010RA group compared to the U\u2010RA group at all time points. (24 h: 6.5 vs. 18, <jats:italic>p<\/jats:italic>\u2009=\u20090.004; 48 h: 18 vs. 37, <jats:italic>p<\/jats:italic>\u2009=\u20090.001; 72 h: 30.5 vs. 57, <jats:italic>p<\/jats:italic>\u2009=\u20090.002). On multivariable analysis, only route of regional anesthesia was independently associated with reduced opioid use across all time points (24 h: mean difference\u2009=\u2009\u22125.75, 95% CI: \u221211.3, \u22120.18; 48 h: mean difference\u2009=\u2009\u221216.95, 95% CI: \u221227.5, \u22126.4; 72 h: mean difference\u2009=\u2009\u221220.39, 95% CI: \u221235.4, \u22125.3) Patient age, gender, race, obesity, neoadjuvant chemotherapy, small pancreatic duct, and pancreatic fistula were not independently associated with opioid use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>O\u2010RA may offer a better approach than U\u2010RA in minimizing opioid consumption after open PD. These findings suggest the incorporation of O\u2010RA for upper abdominal surgeries to decrease the necessity of postoperative opioids.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jso.28074","type":"journal-article","created":{"date-parts":[[2025,1,9]],"date-time":"2025-01-09T06:35:20Z","timestamp":1736404520000},"page":"1343-1351","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Reducing Postoperative Opioid Use: A Comparison of Open Versus Ultrasound\u2010Guided Regional Anesthesia for Patients Undergoing Open Pancreatoduodenectomy"],"prefix":"10.1002","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3968-1205","authenticated-orcid":false,"given":"Parit T.","family":"Mavani","sequence":"first","affiliation":[{"name":"Department of Surgery Emory University School of Medicine Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caitlin","family":"Sok","sequence":"additional","affiliation":[{"name":"Department of Surgery Emory University School of Medicine Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9292-8345","authenticated-orcid":false,"given":"Pranay S.","family":"Ajay","sequence":"additional","affiliation":[{"name":"Department of Surgery Emory University School of Medicine Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tarrant","family":"McPherson","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics Rollins School of Public Health of Emory University Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey","family":"Switchenko","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics Rollins School of Public Health of Emory University Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8694-0455","authenticated-orcid":false,"given":"David A.","family":"Kooby","sequence":"additional","affiliation":[{"name":"Department of Surgery Emory University School of Medicine Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4665-5534","authenticated-orcid":false,"given":"Mihir M.","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Surgery Emory University School of Medicine Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,1,8]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2019.01.001"},{"key":"e_1_2_9_3_1","unstructured":"NSC Odds of Dying 2021 2023 accessed February 14 2023 https:\/\/injuryfacts.nsc.org\/all-injuries\/preventable-death-overview\/odds-of-dying\/data-details\/."},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000625"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000003265"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hpb.2021.10.021"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpsurg.2020.100795"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anclin.2017.01.018"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-020-05462-w"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0038-1676477"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.0898"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e318221f0cf"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-013-2791-0"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.14037"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1318.2012.03104.x"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11695-018-3376-8"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2015.06.008"},{"key":"e_1_2_9_18_1","article-title":"Transversus Abdominis Plane Block: An Updated Review of Anatomy and Techniques","volume":"2017","author":"Tsai H. 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