Comparison Of In-hospital Postoperative Narcotic Use And Pain Score For Carotid Endarterectomy (cea) Vs. Transcarotid Artery Revascularization (tcar)
Evan Neville, MD, L. Graham Rucker, M.D., Whitney Thorne, D.O., Brian Kuhn, M.D., Aaron Kulwicki, M.D., Matthew Recht, M.D., Patrick Muck, M.D..
Trihealth - Good Samaritan Hospital, Cincinnati, OH, USA.
OBJECTIVES:
Healthcare providers are currently facing new increasing restrictions on narcotic prescribing secondary to the ongoing opioid epidemic in the United States. This study aims to compare the postoperative pain scores and narcotics used in carotid endarterectomy (CEA) versus transcarotid revascularization (TCAR) for carotid stenosis. There are no studies published to date with regard to postoperative pain and narcotic use.
METHODS:
A retrospective review was conducted from January 2017 - July 2019 of patients who underwent CEA or TCAR at our institution. The primary outcomes were hospital narcotic use and patient pain scores. Narcotic use was broken down into use during the post anesthesia care unit (PACU), post-operative day (POD), and discharge amount. All narcotic medication was converted to morphine equivalents which aligns with the state of Ohio rules and regulations.
RESULTS:
A total of 237 patients were evaluated in the study; 176 underwent CEA and 61 underwent TCAR. When comparing the patient populations, there was no significant difference between those that underwent CEA vs. TCAR based on categorical demographics and comorbidities. Median (IQR) PACU narcotic use in morphine equivalents was significantly lower for TCAR vs. CEA, 10 (9,20) vs. 20 (14.3, 25.8), respectively (p<0.001). TCAR patients reported significantly lower pain scores than CEA in the PACU, POD 0, and POD1 (p<0.019, p<0.003, p<0.005). Finally, the morphine equivalents at discharge were significantly less for TCAR than CEA (p<0.001).
CONCLUSIONS:
These initial results show that patients undergoing TCAR for carotid stenosis have less pain and require less narcotics when compared to CEA. With the ongoing opioid epidemic sweeping across the country, further analysis should focus on routine postoperative pain control regimens to limit opioid dependence and increase the use of multimodal pain control.
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