Impact of Body Mass Index on postoperative pain and opioïd administration after pressurized intraperitoneal aerosol chemotherapy (PIPAC) in the treatment of peritoneal carcinomatosis.

Abstract

Abstract BACKGROUND Intraperitoneal aerosol spray chemotherapy (PIPAC) is a new surgical technique, developed for the treatment of peritoneal carcinomatosis (PC). In this retrospective observational study we assessed the impact of body mass index (BMI) on postoperative pain and opioid consumption.METHODS We analysed pain scores after 100 PIPAC procedures with either oxaliplatin or doxorubicin-cisplatin performed in 49 patients with PC between July 2016 and September 2020. The patients were divided into 4 groups (BMI < 18.5, 18.5 ≥ BMI < 25, 25 ≥ BMI ≤ 29.9 and BMI ≥ 30). Pain was self-rated on a visual analogue scale (VAS) from 0 to 10.RESULTS Univariate logistic regression analysis identified oxaliplatin to be associated with moderate to severe pain (VAS 4–10 at 8h D1) before (OR [95% CI]; 3.75[1.33–10.54]; p = 0.012) and after adjustment (OR [95% CI]; 4.13[1.41–12.11] p = 0.010) on BMI. The level of pain appeared significantly different between the treatment groups (median 2.5[0; 5] vs 0[0; 2.5] p = 0.0017) irrespective of BMI (p = 0.46 and p = 0.226). Multivariate logistic regression analysis identified moderate to severe pain and synchronous PC to be associated with greater use of opioids (OR [95% CI]: 3.91 [1.24–12.32]) and (OR [95% CI]: 5.16 [1.71–15.58]; respectively. Opioids were administered after 45 procedures (45%) and was comparable between the treatment groups. Opioid administration and length-of-stay were similar among BMI bands.CONCLUSION We conclude that BMI is not related to postoperative pain or opioid use and that moderate to severe pain and synchronous PC are factors associated with requiring opioïds.