437) Hepatic resection is associated with reduced postoperative opioid requirement

Postoperative pain control can significantly affect surgical outcomes including morbidity and length of stay. The purpose of this retrospective study was to compare opiate requirements in patients undergoing open hepatic resection versus open pancreaticoduodenectomy (Whipple procedure). Data from 79 adult patients who underwent liver resections and 80 patients who underwent pancreaticoduodenectomy at Penn State Hershey Medical Center between 01/01/2010-06/30/2013 were studied. All patients received intraoperative general and neuraxial anesthesia. Patients undergoing multiple procedures, remaining intubated for more than 24 hours postoperatively or requiring re-intubation were excluded. Postoperatively, all patients were managed with patient-controlled anesthesia. Pain scores and amount of opioid administered (converted to morphine equivalents) were recorded for the first 48 hours and compared. Hospital and ICU length of stay were also compared. No significant differences in pain scores were found at any time points. However, significantly more opioid was administered to patients undergoing pancreaticoduodenectomy. This was true for the following time points: intraoperative (p=0.0056), first 48 hours postoperatively (p=0.0014), and entire length of stay (p=0.0017). The same trend was demonstrated after controlling for age, sex, Body Mass Index (BMI), and American Society of Anesthesiologists status (adjusted p=0.0059). Total hospital length of stay was also significantly higher in the pancreaticoduodenectomy group (p=0.03). Patients undergoing hepatic resection have a significantly lower opioid requirement. This is likely related to reduced liver volume with subsequent increased opioid bioavailability. Reduction in opioid dosing and more aggressive use of neuraxial anesthetic techniques can be recommended for this patient population.