A new era? pca utilization after opioid law changes

Introduction: Higher utilization of inpatient opioids may result in increased outpatient opioid prescriptions. New laws have led to changes in opioid prescribing to decrease opioid utilization. It is uncertain if Patient Controlled Analgesia (PCA) use remains a viable strategy to decrease inpatient opioid utilization. In 2019, a PCA syringe shortage led to an abrupt discontinuation of PCA for postoperative pain management. The purpose of this study is to compare opioid consumption prior to and following the PCA shortage. Methods: This was a retrospective cohort study at Ascension St. John Hospital evaluating opioid use in adult patients who received postoperative opioid analgesia with PCA vs. conventional management between 2018 to 2021. Patients that were cognitively impaired, received pain medications for indications other than postoperative analgesia, were mechanically ventilated, had pain medication utilization for less than 24 hours, or received epidural anesthesia or local nerve blocks were excluded. The primary outcome was mean daily opioid requirement (MME). Secondary endpoints included efficacy of pain management as assessed by pain score AUC/T, opioid prescription upon discharge, length of stay, and adverse events. Results: A total of 224 patients were included in this study. PCA utilization was associated with an increase in mean daily opioid MME (165 + 99.2 vs. 71.4 + 52.8, p< 0.001). Furthermore, patients managed with a PCA had an increased hospital length of stay (4.2 vs. 3.2 days, p< 0.01) and increased incidence of nausea (33% vs. 17.9%, p < 0.01). No difference was noted in AUC/T (0.19 + 0.07 vs. 0.21 + 0.08, p=0.06) or mean opioid MME prescribed at hospital discharge (150 vs 90, p=0.64). Conclusions: Patients that utilized PCA pumps postoperatively had higher daily opioid requirements, longer hospital length of stay, and an increased incidence of nausea.