Data for: Adherence to non-opioid multimodal analgesia (NOMA) protocol is associated with a shorter length of stay after thoracic surgery

Published: 18 October 2019| Version 2 | DOI: 10.17632/tfx9bnf86z.2
Mindaugas Pranevicius, Denise Sullivan, Jody M. Kaban, MD, FACS, Aurimas Knepa, Leonard Golden, Afshin Parsikia, Jack Kuttz


Study objective: To review the outcomes of non-opioid multimodal analgesia (NOMA) in patients after thoracic surgery. Design: Retrospective one-year cohort. Setting: Single hospital, level one trauma center. Patients. 29 ASA 2-4 patients after thoracotomy (8), open lung biopsy or video-assisted thoracic surgery (VATS) operated by a single surgeon. Interventions: NOMA protocol included intravenous acetaminophen alternating with ketorolac every 3 hours (each every 6 hours, later converted to oral acetaminophen and ibuprofen) with a low dose (0.05mg/kg/h) IV ketamine infusion up to chest tube removal. Opioids were not routinely prescribed from postoperative day one. Measurements: NOMA adherence versus breach (need for >2 opioid rescue doses/24h) rate and it’s association with the perioperative variables and length of stay was explored from the chart review. Main Results: The median (IQR) postoperative opioid requirement was 3 (0-6) doses per hospital stay. 7/29 patients (CI 10-44%) required >2 opioid rescue doses/24 h. Need for opioid rescue was associated with lower BMI and using hydromorphone as oppose to morphine in the recovery room. 3/29 patients were prescribed opioids on discharge. No patients required opioids on follow-up and 63% were pain-free. Median length of stay was 3 (2-5.25) days in NOMA compliant and 9 (6-11) days in opioid rescue groups (P=0.002). In subgroup analysis length of stay reduction was limited to non-thoracotomy patients.



Thoracic Surgery, Opioid, Acetaminophen, Postoperative Analgesia, Ketamine