Underutilization of Non Opioid Pain Medication in Patients Undergoing AAA Repair

Abstract Objectives With increased focus on the opioid crisis, it was our goal to describe rates and risk factors for postoperative use of opioids in patients undergoing AAA repair as well as identify pain modalities that are underutilized. Methods We retrospectively analyzed perioperative analgesic prescriptions for endovascular (EVAR) and open AAA repair between 1/1/2010 to 1/1/2018. Patients' baseline opioid use, demographics, and medical comorbidities were obtained. The EVAR group was further subdivided into percutaneous (pEVAR) and cutdown (cEVAR) groups. Primary outcomes were post-operative and discharge pain medication prescriptions. Relative rates of opioid prescribing were obtained through the electronic medical record and normalized into morphine milligram equivalents (MMEs). Results Of the 128 patients analyzed in the entire cohort, 21.8% (n=28) underwent open repair and 78.12% (n=100) underwent EVAR (46 pEVAR, 54 cEVAR). As expected, open repair had increased post-operative pain reported compared to EVAR (2.67+/-0.75 vs 0.96+/-0.19, p Conclusions This single institutional retrospective study evaluated pain prescription patterns for patients undergoing AAA repair. AAA patients are predominantly treated with opioid pain medications with few adjunctive therapies. Intraoperative epidural and pEVAR may aid in decreasing the total MME used, however, the total number of opioid prescribed are similar for pEVAR and cEVAR despite the difference in approach. Clinicians must consider alternative non-opioid based pain management strategies.