{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T02:12:20Z","timestamp":1782180740200,"version":"3.54.5"},"reference-count":55,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,12,28]],"date-time":"2022-12-28T00:00:00Z","timestamp":1672185600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>This study aimed to investigate the implementation and pain\u2010related outcomes of a peri\u2010operative pain\u2010management regimen for patients undergoing pelvic exenteration surgery at a university teaching hospital.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>This is a single\u2010site prospective observational cohort study involving 100 patients who underwent pelvic exenteration surgery between January 2017 and December 2018. A pain\u2010management algorithm regarding the use of opioid\u2010sparing multimodal analgesia was developed between the departments of anaesthesia, pain management and intensive care. The primary outcomes were: compliance with a pain\u2010treatment algorithm compared with a similar retrospective surgical patient cohort in 2013\u20132014; and requirements for regular doses of opioid analgesia at discharge, measured in oral morphine equivalent daily dose (oMEDD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Following the introduction of a pain\u2010management algorithm, regional anaesthesia techniques (spinal anaesthesia, transversus abdominus plane block, preperitoneal catheters or epidural analgesia) were used in 83\/98 (84.7%) of the 2017\u20132018 cohort compared with 13\/73 (17.8%) of the 2013\u20132014 cohort (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). There was a reduction in the median dose of opioid analgesics (oMEDD) at time of discharge, from 150\u2009mg (interquartile range [IQR]: 75.0\u2013235.0\u00a0mg) in the 2013\u20132014 cohort to 10\u00a0mg (IQR: 0.00\u201345.0\u00a0mg) in the 2017\u20132018 cohort (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). There was no change in pain intensity (assessed using the Verbal Numerical Rating Score) or oMEDD in the first 7\u2009days following surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Since implementation of a novel peri\u2010operative pain\u2010treatment algorithm, the use of opioid\u2010sparing regional techniques and preperitoneal catheters has increased. Additionally, the dose of opioids required at the time of discharge has reduced significantly.<\/jats:p><\/jats:sec>","DOI":"10.1111\/codi.16442","type":"journal-article","created":{"date-parts":[[2022,12,3]],"date-time":"2022-12-03T07:59:28Z","timestamp":1670054368000},"page":"631-639","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Implementation of a peri\u2010operative pain\u2010management algorithm reduces the use of opioid analgesia following pelvic exenteration surgery"],"prefix":"10.1111","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4312-5084","authenticated-orcid":false,"given":"Charlotte S.","family":"Johnstone","sequence":"first","affiliation":[{"name":"Department of Anaesthesia Royal Prince Alfred Hospital  Sydney New South Wales Australia"},{"name":"Surgical Outcomes Research Centre (SOuRCe) Sydney Local Health District &amp; University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cherry E.","family":"Koh","sequence":"additional","affiliation":[{"name":"Surgical Outcomes Research Centre (SOuRCe) Sydney Local Health District &amp; University of Sydney  Sydney New South Wales Australia"},{"name":"Department of Colorectal Surgery Royal Prince Alfred Hospital  Sydney New South Wales Australia"},{"name":"Institute of Academic Surgery. Royal Prince Alfred Hospital  Camperdown New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory J.","family":"Britton","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia Royal Prince Alfred Hospital  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5602-6045","authenticated-orcid":false,"given":"Michael J.","family":"Solomon","sequence":"additional","affiliation":[{"name":"Surgical Outcomes Research Centre (SOuRCe) Sydney Local Health District &amp; University of Sydney  Sydney New South Wales Australia"},{"name":"Department of Colorectal Surgery Royal Prince Alfred Hospital  Sydney New South Wales Australia"},{"name":"Institute of Academic Surgery. Royal Prince Alfred Hospital  Camperdown New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"McLachlan","sequence":"additional","affiliation":[{"name":"Sydney Pharmacy School, Faculty of Medicine and Health University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,12,28]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1245\/aso.2003.03.040"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2002.02.121"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002\u20109610(94)90121\u2010x"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000001013"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2003.08.020"},{"issue":"6","key":"e_1_2_11_7_1","first-page":"539","article-title":"Pelvic exenteration for advanced primary and recurrent adenocarcinoma","volume":"28","author":"Falk RE","year":"1985","journal-title":"Can J Surg"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1037\/hea0000850"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010010\u20101218\u20106"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs5.75"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.11203"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/eja.0000000000001165"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00384\u2010021\u201003939\u20101"},{"key":"e_1_2_11_14_1","unstructured":"Opioid Analgesic Stewardship in Acute Pain Clinical Care Standard Care ACoSaQiH;2022. Available from:https:\/\/www.safetyandquality.gov.au\/publications\u2010and\u2010resources\/resource\u2010library\/opioid\u2010analgesic\u2010stewardship\u2010acute\u2010pain\u2010clinical\u2010care\u2010standard. Accessed September 1 2022."},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/phar.2602"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds.3945"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000002283"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2020.05.061"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/sla.0000000000002817"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0000000000000656"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/eja.0000000000000877"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1177\/1750458920971108"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.2217\/pmt\u20102018\u20100027"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.2147\/jpr.S305146"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.2165\/00003495\u2010200161080\u201000010"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1517\/14656566.6.12.2117"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/s1526\u20105900(03)00716\u20108"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2010.08.016"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542\u2010200306000\u201000017"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1213\/ane.0000000000002864"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/0090-8258(80)90025-6"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.9392"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2021.07.022"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.15036"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520\u2010017\u20103614\u2010y"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1097\/md.0000000000019306"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1177\/0310057X211018211"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1093\/bjsopen\/zraa055"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151\u2010011\u20100720\u20106"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpa.2020.12.001"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.4103\/2229\u20105151.124117"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010007\u20109113\u20104"},{"issue":"2","key":"e_1_2_11_43_1","first-page":"6","article-title":"Non\u2010analgesic effects of thoracic epidural anesthesia","volume":"19","author":"Ulke ZS","year":"2007","journal-title":"Agri"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.3928\/01477447\u201020201007\u201006"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2020.05.098"},{"key":"e_1_2_11_46_1","unstructured":"Anaesthetists FoPMotRCo.Surgery and opioids: best practice guidelines;2021. Available from:https:\/\/www.fpm.ac.uk\/surgery\u2010and\u2010opioids\u2010best\u2010practice\u2010guidelines\u20102021. Accessed March 3 2021."},{"key":"e_1_2_11_47_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2021.792290"},{"key":"e_1_2_11_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pharmthera.2017.10.006"},{"key":"e_1_2_11_49_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2017.00642"},{"key":"e_1_2_11_50_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000002254"},{"key":"e_1_2_11_51_1","volume-title":"Acute Pain Management: Scientific Evidence","author":"Medicine AaNZCoAaFoP","year":"2020"},{"key":"e_1_2_11_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2018.01.008"},{"key":"e_1_2_11_53_1","doi-asserted-by":"publisher","DOI":"10.1097\/nur.0000000000000416"},{"key":"e_1_2_11_54_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304\u20103959(83)90143\u20104"},{"key":"e_1_2_11_55_1","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.bja.a013366"},{"key":"e_1_2_11_56_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2004.09.012"}],"container-title":["Colorectal Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/codi.16442","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/codi.16442","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/codi.16442","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,21]],"date-time":"2023-08-21T19:54:40Z","timestamp":1692647680000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/codi.16442"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,28]]},"references-count":55,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2023,4]]}},"alternative-id":["10.1111\/codi.16442"],"URL":"https:\/\/doi.org\/10.1111\/codi.16442","archive":["Portico"],"relation":{},"ISSN":["1462-8910","1463-1318"],"issn-type":[{"value":"1462-8910","type":"print"},{"value":"1463-1318","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,28]]},"assertion":[{"value":"2022-06-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-11-20","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-12-28","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}