Decreased Opioid Consumption in Bone Marrow Harvest Patients Using Quadratus Lumborum Blocks in a Standardized...

Area of Science:

• Anesthesiology
• Pain Management
• Surgical Oncology

Background:

• Bone marrow harvesting causes significant postoperative pain, leading to variable analgesia practices and high opioid use.
• Lack of uniform guidelines contributes to inconsistent perioperative pain management, particularly concerning opioid administration.
• Opioid stewardship is crucial to mitigate risks associated with narcotic use in surgical patients.

Purpose of the Study:

• To explore the efficacy of preoperative bilateral quadratus lumborum blocks combined with a standardized protocol.
• To reduce perioperative opioid consumption in patients undergoing bone marrow harvest.
• To improve overall opioid stewardship in this patient population.

Main Methods:

• Retrospective and prospective analysis of adult bone marrow donors (n=32) from 2018-2020.
• Comparison of a pre-implementation group (n=19) with an implementation group (n=13) receiving bilateral quadratus lumborum blocks.
• Evaluation of patient demographics, pain scores, and perioperative opioid consumption.

Main Results:

• The implementation group showed significantly reduced median intraoperative (0.0 mg vs. 20.0 mg) and total opioid consumption (0.0 mg vs. 20.5 mg).
• Opioid administration decreased from 84.2% in the pre-implementation group to 23.1% in the implementation group.
• Patient characteristics were similar, with a higher proportion of spinal anesthesia in the implementation group.

Conclusions:

• Implementing a standardized perioperative protocol with bilateral quadratus lumborum blocks effectively reduces opioid use in bone marrow harvest patients.
• This approach achieves reduced perioperative opioid administration without negatively impacting immediate pain control.
• The findings support a new standard of care for managing pain and optimizing opioid stewardship after bone marrow harvest.