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Yi S, Zhang X, Song Y, Wang X, Gao H, Yuan Z, Kong M. The impact of external oblique intercostal block on early postoperative pain and recovery in patients undergoing J-shaped incisions for upper abdominal surgery: a single-center prospective randomized controlled study. BMC Anesthesiol 2025; 25:158. [PMID: 40188045 PMCID: PMC11972538 DOI: 10.1186/s12871-025-03030-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2024] [Accepted: 03/26/2025] [Indexed: 04/07/2025] Open
Abstract
BACKGROUND The aim of this study was to investigate the effects of external oblique intercostal nerve block (EOIB) on early postoperative pain and recovery in patients undergoing J-shaped incision surgery in the upper abdomen. METHODS Patients aged 18-85 years, classified as ASA I-III, undergoing elective open upper abdominal J-shaped incision surgery under general anesthesia were included in this study. Patients were randomized into two groups: the external oblique intercostal nerve block group (Group E ) and the control group (Group C ). Following induction of general anesthesia, Group E received 30 ml of 0.375% ropivacaine and 4 mg dexamethasone for ultrasound-guided EOIB on the surgical side, while Group C received no nerve block. Postoperatively, both groups utilized fentanyl patient-controlled intravenous analgesia. The primary outcome of the study was the 24-hour fentanyl consumption recorded for both groups. Patients with a Numeric Rating Scale (NRS) score > 4 were administered 40 mg parecoxib sodium as rescue analgesia. RESULTS Postoperative fentanyl consumption at 24 h was significantly lower in Group E compared to Group C (832.92 ± 66.42 μg vs. 1021.25 ± 76.63 μg, p = 0.001). Group E demonstrated lower NRS scores at rest and during movement at 0, 2, 4, 12, and 24 h postoperatively compared to Group C, but similar scores at 48 h. The time to first ambulation (49.92 ± 4.21 h vs. 58.38 ± 2.95 h, p = 0.001) and time to first flatus (59.79 ± 2.49 h vs. 67.83 ± 2.48 h, p = 0.001) were both shorter in Group E than in Group C, with higher Quality of Recovery-15 (QoR-15) scores in Group E (108.00 ± 3.80 vs. 97.00 ± 5.13, p = 0.001). CONCLUSION EOIB significantly enhances postoperative analgesia in patients undergoing upper abdominal J-shaped incision surgery, reducing opioid consumption and analgesic requirements, and improving the quality of recovery. It may be considered as part of a multimodal analgesic regimen following upper abdominal surgery. TRIAL REGISTRATION This study was registered in the Chinese Clinical Trial Testing Center (ID: ChiCTR2300076653, 10.13.2023).
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Affiliation(s)
- Shuai Yi
- Department of Anesthesiology, The Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Xuzhou, Jiangsu Province, China
| | - Xinlei Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Xuzhou, Jiangsu Province, China
| | - Yuhong Song
- Department of Anesthesiology, The Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Xuzhou, Jiangsu Province, China
| | - Xiaohui Wang
- Department of Anesthesiology, The Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Xuzhou, Jiangsu Province, China
| | - Han Gao
- Department of Anesthesiology, The Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Xuzhou, Jiangsu Province, China
| | - Zhao Yuan
- Department of General Surgery, The Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Xuzhou, Jiangsu Province, China
| | - Mingjian Kong
- Department of Anesthesiology, The Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Xuzhou, Jiangsu Province, China.
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Ciulli C, Fogliati A, Scacchi A, Scotti MA, Aprigliano M, Braga M, Romano F, Garancini M. Early compliance to enhanced recovery protocol as a predictor of complications after liver surgery. Updates Surg 2025:10.1007/s13304-025-02148-7. [PMID: 40087243 DOI: 10.1007/s13304-025-02148-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 02/26/2025] [Indexed: 03/17/2025]
Abstract
BACKGROUND Enhanced Recovery Protocol (ERP) has the purpose of minimising postoperative hospitalisation and expediting the restoration of preoperative patient conditions. This study seeks to investigate the correlation between early non-compliance to postoperative items within ERP and complications in liver surgery. METHODS From January 2019 to December 2022 the ERP was proposed to all consecutive patients undergoing liver surgery. Nasogastric tube removal, resuming oral intake and mobilisation and obtaining an adequate glycaemic control were the postoperative items considered as non-compliance indicators. Data were prospectively collected and analysed. RESULTS 192 patients were included, comprising 99(51.6%) hepatocellular carcinoma, 58(30.2%) colorectal metastasis and 24(12.5%) benign/other pathology. A minimally invasive approach was adopted in 57.3% of cases. Postoperative morbidities occurred in 44.8% of patients, while major complications in 13% of patients. Cirrhosis (p < 0.001), minimally invasive approach (p < 0.004), early oral intake (p < 0.019) and early mobilisation (p < 0.019) significantly correlated to morbidity at multivariate analysis. The complication rate escalated from 26.9% in fully compliant patients, to 58% in patients with two non-compliance indicators and to 91.2% in fully non-compliant patients (p < 0.001). The same trend was confirmed for major complications (p < 0.001). CONCLUSIONS Early non-compliance to ERP postoperative items in liver surgery was significantly associated with overall and major morbidity.
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Affiliation(s)
- Cristina Ciulli
- HPB Surgery Unit, Department of General Surgery, IRCCS San Gerardo dei Tintori Foundation, Via Pergolesi 33, 20900, Monza, Italy.
| | - Alessandro Fogliati
- HPB Surgery Unit, Department of General Surgery, IRCCS San Gerardo dei Tintori Foundation, Via Pergolesi 33, 20900, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milano, Italy
| | - Andrea Scacchi
- School of Medicine and Surgery, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milano, Italy
| | - Mauro Alessandro Scotti
- HPB Surgery Unit, Department of General Surgery, IRCCS San Gerardo dei Tintori Foundation, Via Pergolesi 33, 20900, Monza, Italy
| | - Michele Aprigliano
- Department of Anesthesiology and Intensive Care Medicine, IRCCS San Gerardo dei Tintori Foundation, Via Pergolesi 33, 20900, Monza, Italy
| | - Marco Braga
- School of Medicine and Surgery, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milano, Italy
| | - Fabrizio Romano
- HPB Surgery Unit, Department of General Surgery, IRCCS San Gerardo dei Tintori Foundation, Via Pergolesi 33, 20900, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milano, Italy
| | - Mattia Garancini
- HPB Surgery Unit, Department of General Surgery, IRCCS San Gerardo dei Tintori Foundation, Via Pergolesi 33, 20900, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milano, Italy
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Tang J, Hua Q, Zhang Y, Nie W, Yu S, Zhang J. Effects of ultrasound-guided external oblique intercostal plane block on the postoperative analgesia after open liver surgery: study protocol for a randomised controlled trial. Trials 2024; 25:776. [PMID: 39550599 PMCID: PMC11568687 DOI: 10.1186/s13063-024-08449-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 09/02/2024] [Indexed: 11/18/2024] Open
Abstract
BACKGROUND Open liver surgery remains a primary surgical approach for complex liver resections and liver transplantation. However, the postoperative pain management is still a major challenge. Ultrasound-guided external oblique intercostal (EOI) plane block is a novel approach of regional anaesthesia and has a great potential to relieve postoperative pain after upper abdominal surgeries. This study aims to investigate the efficacy and safety of ultrasound-guided EOI plane block in managing postoperative pain after open liver surgery. METHODS Seventy-four participants scheduled for open liver surgery will be randomly assigned to either the intervention group, receiving an ultrasound-guided EOI plane block with a single dose of 30 ml 0.375% ropivacaine, or the control group, which will not receive this block. All participants will be provided with opioid-based patient-controlled intravenous analgesia (PCIA) postoperatively. The primary outcome is resting pain score at 3 h postoperatively, assessed using numerical rating scale. Secondary outcomes include pain score at 6, 24, 48, and 72 h postoperatively, perioperative opioid consumption, remedial analgesics within 72 h postoperatively, PCIA usage within postoperative 72 h, postoperative recovery, length of hospital stay, postoperative side effects, block-related complications, and ropivacaine plasma concentration of participants receiving the block. DISCUSSION This study is a randomised controlled trial to evaluate the efficacy and safety of ultrasound-guided EOI plane block for postoperative analgesia after open liver surgery. As regional anaesthesia plays an important role in the multimodal pain management, EOI plane block may prove to be an effective regional technique for enhancing postoperative pain relief and contributing to enhanced recovery after open liver surgery. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2200065745. Registered on November 14, 2022.
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Affiliation(s)
- Jiali Tang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Qingqing Hua
- Department of Anesthesiology, Xingyi People's Hospital, the affiliated hospital of Guizhou Medical University, Xingyi, China
| | - Yuelun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weihua Nie
- Operating Room, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Songlin Yu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinlan Zhang
- Institute of Materia Medica, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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Liu S, Song B, Zhang L, Li X, Cui L. Clinical Trial Study Protocol: A Prospective Blinded, Randomized, Controlled Clinical Trial Protocol to Assess the Efficacy of Ultrasound-Guided Transversus Abdominis Plane Block on Postoperative Analgesia and Recovery Quality in Laparoscopic Donor Hepatectomy. J Pain Res 2024; 17:3401-3408. [PMID: 39464411 PMCID: PMC11512518 DOI: 10.2147/jpr.s476966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 10/18/2024] [Indexed: 10/29/2024] Open
Abstract
Introduction Liver transplantation is considered an effective treatment for end-stage liver disease. Laparoscopic donor hepatectomy (LDH) has become a new standard procedure. And it is important to minimize the pain of the donor. Good postoperative analgesia can reduce the occurrence of postoperative complications and promote the early recovery of the donor. Ultrasound-guided transversus abdominis plane (TAP) block can provide effective analgesia for liver donors and reduce postoperative opioid consumption. This study aims to use ultrasound-guided TAP block for LDH to improve postoperative analgesia for donors while reducing opioid consumption and improving patient rehabilitation quality. Methods/Analysis This study is a prospective blinded, randomized, controlled clinical trial with a concealed allocation of patients (living liver donors) scheduled to receive laparoscopic partial hepatectomy 1:1 to receive local infiltration anesthesia or TAP block. This study will recruit a total of 80 patients. The primary outcome is the dosage of opioids within 24 hours after surgery. Ethics and Dissemination This trial has been approved by the Institutional Review Board of Beijing Friendship Hospital of China Capital University. This trial study protocol was approved on 8 May 2023. The trial will start recruiting patients after being registered on the Chinese Clinical Trial Registry. Trial Registration Number ChiCTR2300071694.
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Affiliation(s)
- Shen Liu
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People’s Republic of China
| | - Bijia Song
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People’s Republic of China
| | - Liang Zhang
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People’s Republic of China
| | - Xiuliang Li
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People’s Republic of China
| | - Lingli Cui
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People’s Republic of China
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Li Z, Zhou L, Li M, Wang W, Wang L, Dong W, Chen J, Gong S. Early mobilization after pancreatic surgery: A randomized controlled trial. Surgery 2024; 176:1179-1188. [PMID: 39054183 DOI: 10.1016/j.surg.2024.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 05/02/2024] [Accepted: 06/13/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Pancreatic surgery has long been burdened with high postoperative morbidity. Early mobilization has been advocated to prevent complications and improve functional capacity. However, there is a lack of high-quality evidence supporting how to implement early mobilization and its independent impact on postoperative outcomes. The aim of this study was to investigate the effectiveness of implementing early mobilization in reducing postoperative complications and enhancing recovery in patients undergoing pancreatic surgery. METHODS We conducted a single-blind, randomized trial in patients who underwent pancreatic surgery in a tertiary hospital in China. Eligible participants were randomly assigned to either the control group or the intervention group. Patients in the control group received usual care, whereas those in the intervention group received the early enforced mobilization protocol. The protocol consisted of 2 key components: professional assistance with the first ambulation on postoperative day 1 and family-involved supervision to achieve daily walking goals. The primary outcome was postoperative complications within 30 days, measured by the Comprehensive Complication Index. Secondary outcomes were postoperative mobilization, time to recovery of gastrointestinal function, postoperative pulmonary complications, pancreatic surgery-specific complications, patient-reported outcome measures, and 30-day readmission and mortality. RESULTS A total of 135 patients were enrolled: 67 in the intervention group and 68 in the control group. The median Comprehensive Complication Index was not statistically significant between groups (mean difference -1.7; 95% confidence interval -8.7 to 0). Patients in the intervention group had earlier first ambulation postoperatively, walked greater distances on postoperative days 1-7, and had earlier time to first defecation. Trends for improvement in patient-reported outcomes showed that scores of Quality of Recovery 15 at postoperative day 3, physical function of Quality of Life Questionnaire C30 at postoperative day 7, and global quality of life at postoperative day 30 were significantly greater in the intervention group. There was no between-group difference in other domains of the Quality of Life Questionnaire C30 or other secondary outcome measures. CONCLUSION Early enforced mobilization intervention did not reduce postoperative complications of patients undergoing pancreatic surgery, but it can enhance postoperative mobilization and improve the recovery of gastrointestinal function and patient-perceived quality of recovery.
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Affiliation(s)
- Zhi Li
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, China
| | - Lili Zhou
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, China
| | - Meixia Li
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, China
| | - Wei Wang
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, China
| | - Lisheng Wang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Wenwen Dong
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, China
| | - Juan Chen
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Shu Gong
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, China.
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Pianngarn I, Lapisatepun W, Kulpanun M, Chotirosniramit A, Junrungsee S, Lapisatepun W. The effectiveness and outcomes of epidural analgesia in patients undergoing open liver resection: a propensity score matching analysis. BMC Anesthesiol 2024; 24:305. [PMID: 39223470 PMCID: PMC11367829 DOI: 10.1186/s12871-024-02697-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Open liver resection necessitates a substantial upper abdominal inverted-L incision, resulting in severe pain and compromising patient recovery. Despite the efficacy of epidural analgesia in providing adequate postoperative analgesia, the potential epidural-related adverse effects should be carefully considered. This study aims to compare the efficacy and safety of continuous epidural analgesia and intravenous analgesia in open liver resection. METHODS A retrospective study was conducted, collecting data from patients who underwent open liver resection between 2007 and 2017. Propensity score matching was implemented to mitigate confounding variables, with patients being matched in a 1:1 ratio based on propensity scores. The primary outcome was the comparison of postoperative morphine consumption at 24, 48, and 72 hours between the two groups. Secondary outcomes included pain scores, postoperative outcomes, and epidural-related adverse effects. RESULTS A total of 612 patients were included, and after matching, there were 204 patients in each group. Opioid consumption at 24, 48, and 72 hours postoperatively was statistically lower in the epidural analgesia group compared to the intravenous analgesia group (p < 0.001). However, there was no significant difference in pain scores (p = 0.422). Additionally, perioperative hypotension requiring treatment, as well as nausea and vomiting, were significantly higher in the epidural analgesia group compared to the intravenous analgesia group (p < 0.001). CONCLUSIONS Epidural analgesia is superior to intravenous morphine in terms of reducing postoperative opioid consumption within the initial 72 h after open liver resection. Nevertheless, perioperative hypotension, which necessitates management, should be approached with consideration and vigilance. TRIAL REGISTRATION The study was registered in the Clinical Trials Registry at www. CLINICALTRIALS gov/ , NCT number: NCT06301932.
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Affiliation(s)
- Isarapong Pianngarn
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Road, T. Sriphum, A. Muang, Chiang Mai, 50200, Thailand
| | - Worakitti Lapisatepun
- Department of Surgery, Division of Hepatobilliary Pancreatic Surgery, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Road, T. Sriphum, A. Muang, Chiang Mai, 50200, Thailand
- Clinical Surgical Research Center, Chiang Mai University, 110 Inthawarorot Road, T. Sriphum, A. Muang, Chiang Mai, 50200, Thailand
| | - Maytinee Kulpanun
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Road, T. Sriphum, A. Muang, Chiang Mai, 50200, Thailand
| | - Anon Chotirosniramit
- Department of Surgery, Division of Hepatobilliary Pancreatic Surgery, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Road, T. Sriphum, A. Muang, Chiang Mai, 50200, Thailand
- Clinical Surgical Research Center, Chiang Mai University, 110 Inthawarorot Road, T. Sriphum, A. Muang, Chiang Mai, 50200, Thailand
| | - Sunhawit Junrungsee
- Department of Surgery, Division of Hepatobilliary Pancreatic Surgery, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Road, T. Sriphum, A. Muang, Chiang Mai, 50200, Thailand
- Clinical Surgical Research Center, Chiang Mai University, 110 Inthawarorot Road, T. Sriphum, A. Muang, Chiang Mai, 50200, Thailand
| | - Warangkana Lapisatepun
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Road, T. Sriphum, A. Muang, Chiang Mai, 50200, Thailand.
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Li Z, Feng W, Zhou L, Gong S. Accuracy of wrist-worn activity trackers for measuring steps in patients after major abdominal surgery: A validation study. Digit Health 2024; 10:20552076241297036. [PMID: 39502479 PMCID: PMC11536558 DOI: 10.1177/20552076241297036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 10/17/2024] [Indexed: 11/08/2024] Open
Abstract
Background Wearable activity trackers provide a simple and objective measurement of postoperative mobilization. However, few have validated the accuracy of trackers in patients after major abdominal surgery. Objective To examine the accuracy of wrist-worn activity trackers to measure steps of patients in early mobilization after major abdominal surgery, and to explore the influence of clinical variables and gait parameters on the accuracy of trackers. Methods Forty-five patients after major abdominal surgery were recruited to participate in modified six-minute walk tests wearing three trackers simultaneously, the Fitbit Inspire HR, Xiaomi MI 4, and HONOR 5. The differences in displayed steps before and after the walking test were considered as the step counts measured by the trackers; the actual steps taken were determined as the average of the values manually counted by two researchers. The intraclass correlation coefficient, Bland-Altman method, mean percentage error, and mean absolute percentage error were used to assess the accuracy of trackers with reference to manual step counts. Results The three trackers undercounted postoperative steps by -65.5% to -23.5%. Analysis showed low-to-good agreement between step counts recorded by trackers and actual steps (ICC = 0.35-0.75); the mean absolute percentage errors ranged from 24.5% to 65.7%. For all trackers, mean absolute percentage errors correlated negatively with postoperative days (r = -0.626 to -0.744), walking speed (r = -0.714 to -0.854), step length (r = -0.466 to -0.615), and cadence (r = -0.681 to -0.790), while there were positive correlations between mean absolute percentage errors and the number of abdominal drains (r = 0.450-0.514). Conclusions The specific activity trackers used in this study might not be reliable tools for measuring steps counts during the walking test in the early postoperative period for patients undergoing major abdominal surgery.
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Affiliation(s)
- Zhi Li
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, China
| | - Weiyan Feng
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, China
| | - Lili Zhou
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, China
| | - Shu Gong
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, China
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Yu C, Liu Y, Tang Z, Zhang H. Enhanced recovery after surgery in patients undergoing craniotomy: A meta-analysis. Brain Res 2023; 1816:148467. [PMID: 37348748 DOI: 10.1016/j.brainres.2023.148467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND AND OBJECTIVE Enhanced recovery after surgery (ERAS) is a multidisciplinary,and evidence-based perioperative care method. It is effective in shortening hospital stays and improving clinical outcomes. However, the application of ERAS in craniotomy lacks reliable evidence. The purpose of this study is to investigate the efficacy and safety of ERAS in craniotomy. METHODS Studies of ERAS in craniotomy were systematically searched in PubMed, Embase, Cochrane, and Web of Science. Primary outcomes (total hospital stay and postoperative hospital stay, hospitalization cost, percent of patients with moderate to severe pain) and secondary outcomes (readmission rate and incidence of complication) were compared between ERAS and traditional perioperative care. RESULT Of the 10 studies included in this meta-analysis, 6 were randomized-controlled trials (RCTs), 3 were cohort studies, and 1 was non-RCT. A total of 1275 patients were included, with 648 in the ERAS group and 627 in the control group. Compared with the control group, the ERAS group had a significantly shortened total length of stay (LOS) (MD = -2.437, 95% CI: -3.616, -1.077, P = 0.001) and postoperative LOS, reduced hospitalization cost (SMD = -0.631, 95% CI: -0.893, -0.369, P = 0.001), and lower percent of patients with moderate to severe pain. There was no significant difference in readmission rate between the two groups. Though, the ERAS group had a significantly lower risk of pneumonia than the control group. CONCLUSION ERAS is safe and effective for craniotomy as it shortens total and postoperative LOS, reduces hospitalization costs, decreases the percent of patients with moderate to severe pain.
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Affiliation(s)
- Chunyang Yu
- Beijing Tiantan Hospital, Capital Medical University, China
| | - Yuqing Liu
- Department of Rehabilitation Medicine, Peking University Third Hospital, China
| | - Zhiqing Tang
- School of Rehabilitation, Capital Medical University, China; Beijing Bo'ai Hospital, China Rehabilitation Research Center, China
| | - Hao Zhang
- School of Rehabilitation, Capital Medical University, China; Beijing Bo'ai Hospital, China Rehabilitation Research Center, China; University of Health and Rehabilitation Sciences, China; Cheeloo College of Medicine, Shandong University, China.
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Xu Y, Ye M, Liu F, Hong Y, Kang Y, Li Y, Li H, Xiao X, Yu F, Zhou M, Zhou L, Jiang C. Efficacy of prolonged intravenous lidocaine infusion for postoperative movement-evoked pain following hepatectomy: a double-blinded, randomised, placebo-controlled trial. Br J Anaesth 2023:S0007-0912(23)00169-1. [PMID: 37202261 DOI: 10.1016/j.bja.2023.03.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/04/2023] [Accepted: 03/11/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND The analgesic effect of intravenous lidocaine varies with the duration of lidocaine infusion and surgery type. We tested the hypothesis that prolonged lidocaine infusion alleviates postoperative pain in patients recovering from hepatectomy over the first 3 postoperative days. METHODS Patients undergoing elective hepatectomy were randomly assigned to receive prolonged i.v. lidocaine treatment or placebo. The primary outcome was incidence of moderate-to-severe movement-evoked pain at 24 h postoperatively. The secondary outcomes included incidence of moderate-to-severe pain during movement and at rest throughout the first 3 postoperative days, postoperative opioid consumption, and pulmonary complications. Plasma lidocaine concentration was also monitored. RESULTS We enrolled 260 subjects. Intravenous lidocaine lowered the incidence of moderate-to-severe movement-evoked pain at 24 h and 48 h postoperatively (47.7% vs 67.7%, P=0.001; 38.5% vs 58.5%, P=0.001) and reduced movement-evoked pain scores (3.7 [1.7] vs 4.2 [1.6]; mean difference 0.5 [95% confidence interval {CI}: 0.1-0.9]; P=0.018) and morphine equivalent consumption (47.2 [16.7] mg vs 52.6 [19.2] mg; mean difference 5.4 mg [95% CI: 1.0-9.8]; P=0.016) at 24 h postoperatively. Lidocaine also lowered the incidence of postoperative pulmonary complications (23.1% vs 38.5%; P=0.007). Median plasma lidocaine concentrations were 1.5, 1.9, and 1.1 μg ml-1 (inter-quartile ranges: 1.1-2.1, 1.4-2.6, and 0.8-1.6, respectively) after bolus injection, at the end of the surgery, and 24 h postoperatively. CONCLUSIONS Prolonged intravenous lidocaine infusion reduced the incidence of moderate-to-severe movement-evoked pain for 48 h after hepatectomy. However, the reduction in pain scores and opioid consumption by lidocaine was below the minimal clinically important difference. CLINICAL TRIAL REGISTRATION NCT04295330.
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Affiliation(s)
- Yan Xu
- Department of Anaesthesiology, West China Hospital, Sichuan University & The Research Units of West China, Chinese Academy of Medical Sciences, Chengdu, China
| | - Mao Ye
- Department of Anaesthesiology, West China Hospital, Sichuan University & The Research Units of West China, Chinese Academy of Medical Sciences, Chengdu, China
| | - Fei Liu
- Department of Anaesthesiology, West China Hospital, Sichuan University & The Research Units of West China, Chinese Academy of Medical Sciences, Chengdu, China
| | - Ying Hong
- Department of Anaesthesiology, West China Hospital, Sichuan University & The Research Units of West China, Chinese Academy of Medical Sciences, Chengdu, China
| | - Yi Kang
- Department of Anaesthesiology and Translational Neuroscience Centre, Laboratory of Anaesthesia and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yue Li
- Department of Anaesthesiology, West China Hospital, Sichuan University & The Research Units of West China, Chinese Academy of Medical Sciences, Chengdu, China
| | - Huan Li
- Department of Anaesthesiology, Affiliated Hospital of Xiangnan University, Chenzhou, China
| | - Xiao Xiao
- Department of Anaesthesiology, West China Hospital, Sichuan University & The Research Units of West China, Chinese Academy of Medical Sciences, Chengdu, China
| | - Feng Yu
- Department of Anaesthesiology, West China Hospital, Sichuan University & The Research Units of West China, Chinese Academy of Medical Sciences, Chengdu, China
| | - Mengmeng Zhou
- Department of Anaesthesiology, West China Hospital, Sichuan University & The Research Units of West China, Chinese Academy of Medical Sciences, Chengdu, China
| | - Li Zhou
- Department of Anaesthesiology, West China Hospital, Sichuan University & The Research Units of West China, Chinese Academy of Medical Sciences, Chengdu, China.
| | - Chunling Jiang
- Department of Anaesthesiology, West China Hospital, Sichuan University & The Research Units of West China, Chinese Academy of Medical Sciences, Chengdu, China.
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10
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Jongkatkorn C, Luvira V, Suwanprinya C, Piampatipan K, Leeratanakachorn N, Tipwaratorn T, Titapun A, Srisuk T, Theeragul S, Jarearnrat A, Thanasukarn V, Pugkhem A, Khuntikeo N, Pairojkul C, Kamsa-Ard S, Bhudhisawasdi V. Compliance with enhanced recovery after surgery predicts long-term outcome after hepatectomy for cholangiocarcinoma. World J Gastrointest Surg 2023; 15:362-373. [PMID: 37032797 PMCID: PMC10080603 DOI: 10.4240/wjgs.v15.i3.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/09/2022] [Accepted: 02/28/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) program has been proved to improve postoperative outcome for many surgical procedures, including liver resection. There was limited evidence regarding the feasibility and benefit of ERAS in patients who underwent liver resection for cholangiocarcinoma.
AIM To evaluate the feasibility of ERAS in patients who underwent liver resection for cholangiocarcinoma and its association with patient outcomes.
METHODS We retrospectively analyzed 116 cholangiocarcinoma patients who underwent hepatectomy at Srinagarind Hospital, Khon Kaen University between January 2015 and December 2016. The primary outcome was the compliance with ERAS. To determine the association between ERAS compliance and patient outcomes. the patients were categorized into those adhering more than and equal to 50% (ERAS ≥ 50), and below 50% (ERAS < 50) of all components. Details on type of surgical procedure, preoperative and postoperative care, tumor location, postoperative laboratory results, and survival time were evaluated. The compliance with ERAS was measured by the percentage of ERAS items achieved. The Kaplan-Meier curve was used for survival analysis.
RESULTS The median percentage of ERAS goals achieved was 40% (± 12%). Fourteen patients (12.1%) were categorized into the ERAS ≥ 50 group, and 102 patients were in the ERAS < 50 group. Postoperative hospital stay was significantly shorter in the ERAS ≥ 50 group [8.9 d, 95% confidence interval (CI): 7.3-10.4 d] than in the ERAS < 50 group (13.7 d, 95%CI: 12.2-15.2 d) (P = 0.0217). No hepatobiliary-related complications or in-hospital mortality occurred in the ERAS ≥ 50 group. Overall survival was significantly higher in the ERAS ≥ 50 group. The median survival of the patients in the ERAS < 50 group was 1257 d (95%CI: 853.2-1660.8 d), whereas that of the patients in the ERAS ≥ 50 group was not reached.
CONCLUSION Overall ERAS compliance for patients who underwent liver resection for cholangiocarcinoma is poor. Greater ERAS compliance could predict in-hospital, short-term, and long-term outcomes of the patients.
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Affiliation(s)
| | - Vor Luvira
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Chalisa Suwanprinya
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | | | | | - Theerawee Tipwaratorn
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Attapol Titapun
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Tharatip Srisuk
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Suapa Theeragul
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Apiwat Jarearnrat
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Vasin Thanasukarn
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Ake Pugkhem
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Narong Khuntikeo
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Chawalit Pairojkul
- Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Supot Kamsa-Ard
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen 40002, Thailand
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11
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Lott N, Smith S, Gani J, Reeves P. Intermittent pneumatic compression devices: time to reassess the evidence. ANZ J Surg 2023; 93:812-814. [PMID: 36847144 DOI: 10.1111/ans.18342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 02/09/2023] [Indexed: 03/01/2023]
Affiliation(s)
- Natalie Lott
- Surgical Services, John Hunter Hospital, Newcastle, New South Wales, Australia.,Hunter Surgical Clinical Research Unit, John Hunter Hospital, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Stephen Smith
- Surgical Services, John Hunter Hospital, Newcastle, New South Wales, Australia.,Hunter Surgical Clinical Research Unit, John Hunter Hospital, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.,Department of Surgery, Calvary Mater Hospital, New South Wales, Newcastle, Australia
| | - Jonathan Gani
- Hunter Surgical Clinical Research Unit, John Hunter Hospital, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Penny Reeves
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.,Health Economics, Hunter Medical and Research Institute, Newcastle, New South Wales, Australia
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12
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Mostafa M, Mousa MS, Hasanin A, Arafa AS, Raafat H, Ragab AS. Erector spinae plane block versus subcostal transversus abdominis plane block in patients undergoing open liver resection surgery: A randomized controlled trial. Anaesth Crit Care Pain Med 2023; 42:101161. [PMID: 36154912 DOI: 10.1016/j.accpm.2022.101161] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/16/2022] [Accepted: 09/16/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to compare the analgesic efficacy of erector spinae plane block (ESPB) in relation to subcostal transversus abdominis plane block (TAPB) in patients undergoing open liver resection surgery. METHODS In this randomized controlled trial, we included adult patients undergoing open liver resection surgery. After induction of general anaesthesia, the included patients were randomized to receive either ESPB (n = 30) or subcostal TAPB (n = 30). Postoperative pain was assessed using the numeric rating scale (NRS) at rest and during cough. Intravenous morphine boluses were used for management of breakthrough pain intra- and postoperatively. The study's primary outcome was morphine consumption during the first 24 h postoperatively. Secondary outcomes included intraoperative morphine consumption, time to first postoperative morphine requirement, incidence of complications, and patient satisfaction. RESULTS Sixty patients were included and were available for the final analysis in this study. The intra-and postoperative morphine consumption were less in the ESPB group than the subcostal TAPB group (median [quartiles] morphine dose: 0 [0-0] vs 2 [0-5] mg, p = 0.007 and 20 [15-20] vs 25 [20-30] mg, p = 0.006, respectively). The time to first morphine requirement was longer in the ESPB group (median [quartiles]: 6.5 [5.5-6.5] h) than the subcostal TAPB group (median [quartiles]: 4.3 [1.0-6.5] h), P = 0.013. Patients in the ESPB group had lower incidence of sedation and higher level of satisfaction than the subcostal TAPB group. CONCLUSION In patients undergoing open liver resection surgery, ESPB provided superior analgesic properties than subcostal TAPB. CLINICAL TRIAL REGISTRATION NCT05253079, Principal investigator: Maha Mostafa, Date of registration: February 23, 2022. URL: https://clinicaltrials.gov/ct2/show/NCT05253079.
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Affiliation(s)
- Maha Mostafa
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt.
| | - Maggie Saeed Mousa
- Department of Anesthesia and Critical Care Medicine, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ahmed Hasanin
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
| | - Amany S Arafa
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
| | - Heba Raafat
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Shaker Ragab
- Department of Anesthesia and Critical Care Medicine, National Cancer Institute, Cairo University, Cairo, Egypt
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13
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Liu B, Liu S, Zheng T, Lu D, Chen L, Ma T, Wang Y, Gao G, He S. Neurosurgical enhanced recovery after surgery ERAS for geriatric patients undergoing elective craniotomy: A review. Medicine (Baltimore) 2022; 101:e30043. [PMID: 35984154 PMCID: PMC9388027 DOI: 10.1097/md.0000000000030043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Population aging is an unprecedented, multifactorial, and global process that poses significant challenges to healthcare systems. Enhanced recovery after surgery (ERAS) protocols aim to optimize perioperative care. The first neurosurgical ERAS protocol for elective craniotomy has contributed to a shortened postoperative hospital stay, accelerated functional recovery, improved patient satisfaction, and reduced medical care cost in adult patients aged 18 to 65 years compared with conventional perioperative care. However, ERAS protocols for geriatric patients over 65 years of age undergoing cranial surgery are lacking. In this paper, we propose a novel ERAS protocol for such patients by reviewing and summarizing the key elements of successful ERAS protocols/guidelines and optimal perioperative care for geriatric patients described in the literature, as well as our experience in applying the first neurosurgical ERAS protocol for a quality improvement initiative. This proposal aimed to establish an applicable protocol for geriatric patients undergoing elective craniotomy, with evidence addressing its feasibility, safety, and potential efficacy. This multimodal, multidisciplinary, and evidence-based ERAS protocol includes preoperative, intraoperative, and postoperative assessment and management as well as outcome measures. The implementation of the current protocol may hold promise in reducing perioperative morbidity, enhancing functional recovery, improving postoperative outcomes in geriatric patients scheduled for elective craniotomy, and serving as a stepping stone to promote further research into the advancement of geriatric patient care.
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Affiliation(s)
- Bolin Liu
- Department of Neurosurgery, Xi’an International Medical Center, Xi’an, China
| | - Shujuan Liu
- Department of Obstetrics and Gynecology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Tao Zheng
- Department of Neurosurgery, Xi’an International Medical Center, Xi’an, China
| | - Dan Lu
- Department of Neurosurgery, Xi’an International Medical Center, Xi’an, China
| | - Lei Chen
- Department of Neurosurgery, Xi’an International Medical Center, Xi’an, China
| | - Tao Ma
- Department of Neurosurgery, Xi’an International Medical Center, Xi’an, China
| | - Yuan Wang
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi’an, China
| | - Guodong Gao
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi’an, China
| | - Shiming He
- Department of Neurosurgery, Xi’an International Medical Center, Xi’an, China
- Department of Obstetrics and Gynecology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
- *Correspondence: Shiming He, Department of Neurosurgery, Xi’an International Medical Center, No. 777 Xitai Road, Xi’an 710100, China (e-mail: ; )
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14
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Ding L, Chen D, Chen Y, Wei X, Zhang Y, Liu F, Li Q. Intrathecal hydromorphone for analgesia after partial hepatectomy: a randomized controlled trial. Reg Anesth Pain Med 2022; 47:rapm-2021-103452. [PMID: 35977778 DOI: 10.1136/rapm-2021-103452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 08/06/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION There is substantial interest in adding intrathecal opioids, such as hydromorphone to the multimodal pain management strategies. We conducted a randomized controlled trial to examine whether adding intrathecal hydromorphone to a multimodal strategy could safely improve analgesic efficacy for patients undergoing partial hepatectomy. METHODS A total of 126 adult patients undergoing partial hepatectomy under general anesthesia were randomly assigned to receive intrathecal hydromorphone (100 μg) or no block. The primary outcome was the incidence of moderate to severe pain during movement at 24 hours after surgery. Secondary outcomes included the incidence of moderate to severe pain during rest or movement at different times within 72 hours, pain scores during rest or movement within 72 hours after surgery, analgesic use, adverse events, and indicators of postoperative recovery. RESULTS Among the 124 patients analyzed, the intrathecal hydromorphone group showed a lower incidence of moderate to severe pain during movement at 24 hours after surgery (29.0% vs 50%; RR 0.58, 95% CI 0.37 to 0.92) than the control group. However, the absolute difference in pain scores on a numerical rating scale was less than 1 between the two groups at 24 hours after surgery. Mild pruritus within the first 24 hours after surgery was more frequent in the intrathecal hydromorphone group (19.4% vs 4.8%; p=0.01). DISCUSSION Intrathecal hydromorphone 100 μg reduced the incidence of moderate to severe pain and pain scores during movement within 24 hours after partial hepatectomy. However, the difference in pain scores may not be clinically significant, and intrathecal hydromorphone 100 μg did not significantly improve other analgesic or functional outcomes. Further investigation is needed to optimize the intrathecal hydromorphone dose. TRIAL REGISTRATION NUMBER ChiCTR2000030652.
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Affiliation(s)
- Lin Ding
- Department of Anesthesiology, West China Hospital of Medicine, Chengdu, Sichuan, China
| | - Dongxu Chen
- Department of Anesthesiology, West China Hospital of Medicine, Chengdu, Sichuan, China
| | - Yu Chen
- Department of Anesthesiology, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, Sichuan, China
| | - Xiongli Wei
- Department of Anesthesiology, Liuzhou Worker's Hospital, Liuzhou, Guangxi, China
| | - Yabing Zhang
- Department of Anesthesiology, West China Hospital of Medicine, Chengdu, Sichuan, China
| | - Fei Liu
- Department of Anesthesiology, West China Hospital of Medicine, Chengdu, Sichuan, China
| | - Qian Li
- Department of Anesthesiology, West China Hospital of Medicine, Chengdu, Sichuan, China
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15
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Wang Y, Xue YF, Zhao BF, Guo SC, Ji PG, Liu JH, Wang N, Chen F, Zhai YL, Wang Y, Xue YR, Gao GD, Qu Y, Wang L. Real-World Implementation of Neurosurgical Enhanced Recovery After Surgery Protocol for Gliomas in Patients Undergoing Elective Craniotomy. Front Oncol 2022; 12:860257. [PMID: 35686112 PMCID: PMC9171236 DOI: 10.3389/fonc.2022.860257] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 04/11/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To design a multidisciplinary enhanced recovery after surgery (ERAS) protocol for glioma patients undergoing elective craniotomy and evaluate its clinical efficacy and safety after implementation in a tertiary neurosurgical center in China. METHODS ERAS protocol for glioma patients was developed and modified based on the best available evidence. Patients undergoing elective craniotomy for treatment of glioma between September 2019 to May 2021 were enrolled in a randomized clinical trial comparing a conventional neurosurgical perioperative care (control group) to an ERAS protocol (ERAS group). The primary outcome was postoperative hospital length of stay (LOS). Secondary outcomes were 30-day readmission rate, postoperative complications, duration of the drainage tube, time to first oral fluid intake, time to ambulation and functional recovery status. RESULTS A total of 151 patients were enrolled (ERAS group: n = 80; control group: n = 71). Compared with the control group, postoperative LOS was significantly shorter in the ERAS group (median: 5 days vs. 7 days, p<0.0001). No 30-day readmission or reoperation occurred in either group. The time of first oral intake, urinary catheter removal within 24 h and early ambulation on postoperative day (POD) 1 were earlier and shorter in the ERAS group compared with the control group (p<0.001). No statistical difference was observed between the two groups in terms of surgical- and nonsurgical-related complications. Functional recovery in terms of Karnofsky Performance Status (KPS) scores both at discharge and 30-day follow-up was similar in the two groups. Moreover, no significant difference was found between the two groups in the Hospital Anxiety and Depression Scale (HADS) scores. CONCLUSION The implementation of the ERAS protocol for glioma patients offers significant benefits over conventional neurosurgical perioperative management, as it is associated with enhancing postoperative recovery, without additional perioperative complications and risks. CLINICAL TRIAL REGISTRATION Chinese Clinical Trial Registry (http://www.chictr.org.cn/showproj.aspx?proj=42016), identifier ChiCTR1900025108.
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Affiliation(s)
- Yuan Wang
- Department of Neurosurgery, Tangdu Hospital, Airforce Medical University, Xi’an, China
| | - Ya-Fei Xue
- Department of Neurosurgery, Tangdu Hospital, Airforce Medical University, Xi’an, China
| | - Bin-Fang Zhao
- Department of Neurosurgery, Tangdu Hospital, Airforce Medical University, Xi’an, China
| | - Shao-Chun Guo
- Department of Neurosurgery, Tangdu Hospital, Airforce Medical University, Xi’an, China
| | - Pei-Gang Ji
- Department of Neurosurgery, Tangdu Hospital, Airforce Medical University, Xi’an, China
| | - Jing-Hui Liu
- Department of Neurosurgery, Tangdu Hospital, Airforce Medical University, Xi’an, China
| | - Na Wang
- Department of Neurosurgery, Tangdu Hospital, Airforce Medical University, Xi’an, China
| | - Fan Chen
- Department of Neurosurgery, Tangdu Hospital, Airforce Medical University, Xi’an, China
| | - Yu-Long Zhai
- Department of Neurosurgery, Tangdu Hospital, Airforce Medical University, Xi’an, China
| | - Yue Wang
- Department of Health Statistics, Airforce Medical University, Xi’an, China
| | - Yan-Rong Xue
- National Time Service Center, Chinese Academy of Sciences, Xi’an, China
- School of Optoelectronics, University of Chinese Academy of Sciences, Beijing, China
| | - Guo-Dong Gao
- Department of Neurosurgery, Tangdu Hospital, Airforce Medical University, Xi’an, China
| | - Yan Qu
- Department of Neurosurgery, Tangdu Hospital, Airforce Medical University, Xi’an, China
| | - Liang Wang
- Department of Neurosurgery, Tangdu Hospital, Airforce Medical University, Xi’an, China
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16
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The power of suction: Theory and practice in closed suction vs gravity drains and postoperative pancreatic fistulas. Am J Surg 2022; 224:737-741. [DOI: 10.1016/j.amjsurg.2022.02.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/28/2022] [Accepted: 02/25/2022] [Indexed: 11/17/2022]
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17
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Feng S, Xie B, Li Z, Zhou X, Cheng Q, Liu Z, Tao Z, Zhang M. Retrospective Study on the Application of Enhanced Recovery After Surgery Measures to Promote Postoperative Rehabilitation in 50 Patients With Brain Tumor Undergoing Craniotomy. Front Oncol 2021; 11:755378. [PMID: 34868964 PMCID: PMC8633504 DOI: 10.3389/fonc.2021.755378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/21/2021] [Indexed: 01/05/2023] Open
Abstract
Objective To investigate whether enhanced recovery after surgery (ERAS) can promote rehabilitation of patients after neurosurgical craniotomy. Methods The clinical data of 100 patients with brain tumor undergoing craniotomy in the Department of Neurosurgery, Xiangya Hospital, Central South University, from January 2018 to August 2020 were collected, including 50 patients in the ERAS group and 50 patients in the control group. t-Test, Wilcoxon’s rank sum test, and chi-square analysis were used to compare the clinical characteristics, prognosis, and hospitalization time between the two groups. Results There was no significant difference in gender, age, and other general clinical data between the two groups (p > 0.05). The days of antiemetic drugs applied in the ERAS group were less than those in the control group (1.00 vs. 2.00 days, p = 0.003), and the proportion of patients requiring analgesics was lower than that of the control group (30% vs. 52%, OR = 0.41, 95% CI 0.18–0.93, p = 0.031). The time of urinary catheter removal and that of patients starting ambulation in the ERAS group were shorter than those in the control group (16.00 vs. 24.00 h, and 1.00 vs. 2.00 days, p < 0.001, respectively); and the hospital length of stay (LOS) in the ERAS group was shorter than that in the control group (Total LOS, 13.00 vs. 15.50 days; Postoperative LOS, 7.00 vs. 10.00 days, p < 0.001). By analyzing the prognosis of patients in the ERAS group and control group, we found that there was no significant difference in postoperative complications and Karnofsky Performance Status (KPS) score 1 month after operation between the two groups. Conclusion The application of ERAS in craniotomy can accelerate the postoperative recovery of patients without increasing the perioperative risk, which is worthy of wide application. However, whether the ERAS measures can reduce the postoperative complications and improve the prognosis of patients still needs more large-scale case validation and multicenter collaborative study.
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Affiliation(s)
- SongShan Feng
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Bo Xie
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - ZhenYan Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - XiaoXi Zhou
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Quan Cheng
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - ZhiXiong Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - ZiRong Tao
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, China
| | - MingYu Zhang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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18
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Prokopowicz A, Byrka K. Effectiveness of mental simulations on the early mobilization of patients after cesarean section: a randomized controlled trial. Sci Rep 2021; 11:22634. [PMID: 34811410 PMCID: PMC8608872 DOI: 10.1038/s41598-021-02036-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 11/01/2021] [Indexed: 11/25/2022] Open
Abstract
We aimed to investigate whether psychological intervention (single mental simulation) among women after cesarean surgery (CC) can affect their willingness to verticalize, actual verticalization, and the duration of the first mobilization. In this prospective randomised, controlled study, 150 women after CC were divided into 3 groups: experimental group with process-simulation with elements of relaxation, experimental group with outcome-simulation with elements of relaxation and control group with elements of relaxation only. After a 5-h stay in the post-operative room, women listened to a recording with a stimulation. Pain and anxiety of verticalization were measured before and after listening to the recording and after verticalization. Almost 12% more patients verticalized in the process-simulation group than in the control group. Percentages of mobilized patients were: 39.4% the process-simulation group; 32.8% in the outcome-simulation group; 27.7% controls (p = 0.073). Mobilization was 5 min longer in the process-simulation group then in control (p < 0.01). Anxiety after the simulation was a significant covariate of the willingness to verticalize, actual verticalization and time spent in mobilization. We conclude that a single mental simulation can effectively motivate patients for their first verticalization after CC. Perceived anxiety before verticalization may affect the effectiveness of interventions, so we recommend to check it at the postoperative care. ClinicalTrials.gov Identifier: NCT04829266.
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Affiliation(s)
- Anna Prokopowicz
- Division of Midwifery and Gynaecological Nursing, Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, ul. Kazimierza Bartla 5, 50-996, Wrocław, Poland. .,Department of Gynecology and Obstetrics, University Hospital in Wroclaw, Wrocław, Poland.
| | - Katarzyna Byrka
- Faculty of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Wrocław, Poland
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19
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Nari GA, Gutierrez EC, Layun JL, Falgueras L, Mariot D, Ferret G, Caula C, Góngora J. THERE ARE NO ADVANTAGES BETWEEN LAPAROSCOPIC AND OPEN LIVER RESECTIONS WITHIN AN ENHANCED RECOVERY PROGRAM (ERAS). ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2021; 34:e1593. [PMID: 34669883 PMCID: PMC8521870 DOI: 10.1590/0102-672020210002e1593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/23/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The use of a successful Enhanced Recovery After Surgery (ERAS) in colorectal surgery favored its application in other organs, and hepatic resections were not excluded from this tendency. Some authors suggest that the laparoscopic approach is a central element to obtain better results. AIM To compare the laparoscopic vs. open hepatic resections within an ERAS to evaluate if there are any differences between them. METHODS In a descriptive study 80 hepatic resections that were divided into two groups, regarding to whether they were submitted to laparoscopy or open surgery. Demographic data, those referring to the hepatectomy and the ERAS was analyzed. RESULTS Forty-seven resections were carried out in open surgery and the rest laparoscopically; in the first group there was only one conversion to open surgery. Of the total, 17 resections were major hepatectomies and in 18 simultaneous resections. There were no differences between procedures regarding hospital stay and number of complications. There was a greater adherence to the ERAS (p=0.046) and a faster ambulation (p=0.001) in the open surgery. CONCLUSION The procedure, whether open or laparoscopically done in hepatic resections, does not seem to show differences in an ERAS evaluation.
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Affiliation(s)
| | | | - Jose Luis Layun
- Hospital Transito Caceres de Allende, Cirugía, Córdoba, Argentina
| | - Laia Falgueras
- Servicio de Cirugia Hepatobiliopancreatica, Hospital Josep Trueta, Girona, Espanha
| | - Daniela Mariot
- Hospital Transito Caceres de Allende, Cirugía, Córdoba, Argentina
| | - Georgina Ferret
- Servicio de Cirugia Hepatobiliopancreatica, Hospital Josep Trueta, Girona, Espanha
| | - Celia Caula
- Servicio de Cirugia Hepatobiliopancreatica, Hospital Josep Trueta, Girona, Espanha
| | - Javier Góngora
- Instituto de Salubridad del Estado de Aguascalientes, Estadisticas, Aguascalientes, México
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Golder HJ, Papalois V. Enhanced Recovery after Surgery: History, Key Advancements and Developments in Transplant Surgery. J Clin Med 2021; 10:1634. [PMID: 33921433 PMCID: PMC8069722 DOI: 10.3390/jcm10081634] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/23/2021] [Accepted: 04/08/2021] [Indexed: 12/13/2022] Open
Abstract
Enhanced recovery after surgery (ERAS) aims to improve patient outcomes by controlling specific aspects of perioperative care. The concept was introduced in 1997 by Henrik Kehlet, who suggested that while minor changes in perioperative practise have no significant impact alone, incorporating multiple changes could drastically improve outcomes. Since 1997, significant advancements have been made through the foundation of the ERAS Society, responsible for creating consensus guidelines on the implementation of enhanced recovery pathways. ERAS reduces length of stay by an average of 2.35 days and healthcare costs by $639.06 per patient, as identified in a 2020 meta-analysis of ERAS across multiple surgical subspecialties. Carbohydrate loading, bowel preparation and patient education in the pre-operative phase, goal-directed fluid therapy in the intra-operative phase, and early mobilisation and enteral nutrition in the post-operative phase are some of the interventions that are commonly implemented in ERAS protocols. While many specialties have been quick to incorporate ERAS, uptake has been slow in the transplantation field, leading to a scarcity of literature. Recent studies reported a 47% reduction in length of hospital stay (LOS) in liver transplantation patients treated with ERAS, while progress in kidney transplantation focuses on pain management and its incorporation into enhanced recovery protocols.
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21
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Tang JH, Wang B, Chow JLJ, Joseph PM, Chan JY, Abdul Rahman N, Low YH, Tan YP, Shelat VG. Improving postoperative mobilisation rates in patients undergoing elective major hepatopancreatobiliary surgery. Postgrad Med J 2021; 97:239-247. [PMID: 33184138 DOI: 10.1136/postgradmedj-2020-138650] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/19/2020] [Accepted: 09/30/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Early mobilisation reduces postoperative complications such as pneumonia, deep vein thrombosis and hospital length of stay. Many authors have reported poor compliance with early mobilisation within Enhanced Recovery After Surgery initiatives. OBJECTIVES The primary objective was to increase postoperative day (POD) 2 mobilisation rate from 23% to 75% in patients undergoing elective major hepatopancreatobiliary (HPB) surgery within 6 months. METHODS We report a multidisciplinary team clinical practice improvement project (CPIP) to improve postoperative mobilisation of patients undergoing elective major HPB surgery. We identified the common barriers to mobilisation and analysed using the fishbone or cause-and-effect diagram and Pareto chart. A series of Plan-Do-Study-Act cycles followed this. We tracked the rate of early mobilisation and mean distance walked. In the post hoc analysis, we examined the potential cost savings based on reduced hospital length of stay. RESULTS Mobilisation rate on POD 2 following elective major HPB surgery improved from 23% to 78.9%, and this sustained at 6 months after the CPIP. Wound pain was the most common reason for failure to ambulate on POD 2. Hospital length of stay reduced from a median of 8 days to 6 days with an estimated cost saving of S$2228 per hospital stay. CONCLUSION Multidisciplinary quality improvement intervention effort resulted in an improved POD 2 mobilisation rate for patients who underwent elective major HPB surgery. This observed outcome was sustained at 6 months after completion of the CPIP with potential cost savings.
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Affiliation(s)
- Jun Han Tang
- General Surgery, Tan Tock Seng Hospital, Singapore
| | - Bei Wang
- General Surgery, Tan Tock Seng Hospital, Singapore
| | | | | | | | | | - Yi Hui Low
- General Surgery, Tan Tock Seng Hospital, Singapore
| | - Yen Pin Tan
- General Surgery, Tan Tock Seng Hospital, Singapore
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22
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Dieu A, Huynen P, Lavand'homme P, Beloeil H, Freys SM, Pogatzki-Zahn EM, Joshi GP, Van de Velde M. Pain management after open liver resection: Procedure-Specific Postoperative Pain Management (PROSPECT) recommendations. Reg Anesth Pain Med 2021; 46:433-445. [PMID: 33436442 PMCID: PMC8070600 DOI: 10.1136/rapm-2020-101933] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/20/2020] [Accepted: 12/22/2020] [Indexed: 02/07/2023]
Abstract
Background and objectives Effective pain control improves postoperative rehabilitation and enhances recovery. The aim of this review was to evaluate the available evidence and to develop recommendations for optimal pain management after open liver resection using Procedure-Specific Postoperative Pain Management (PROSPECT) methodology. Strategy and selection criteria Randomized controlled trials (RCTs) published in the English language from January 2010 to October 2019 assessing pain after liver resection using analgesic, anesthetic or surgical interventions were identified from MEDLINE, Embase and Cochrane databases. Results Of 121 eligible studies identified, 31 RCTs and 3 systematic reviews met the inclusion criteria. Preoperative and intraoperative interventions that improved postoperative pain relief were non-steroidal anti-inflammatory drugs, continuous thoracic epidural analgesia, and subcostal transversus abdominis plane (TAP) blocks. Limited procedure-specific evidence was found for intravenous dexmedetomidine, intravenous magnesium, intrathecal morphine, quadratus lumborum blocks, paravertebral nerve blocks, continuous local anesthetic wound infiltration and postoperative interpleural local anesthesia. No evidence was found for intravenous lidocaine, ketamine, dexamethasone and gabapentinoids. Conclusions Based on the results of this review, we suggest an analgesic strategy for open liver resection, including acetaminophen and non-steroidal anti-inflammatory drugs, combined with thoracic epidural analgesia or bilateral oblique subcostal TAP blocks. Systemic opioids should be considered as rescue analgesics. Further high-quality RCTs are needed to confirm and clarify the efficacy of the recommended analgesic regimen in the context of an enhanced recovery program.
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Affiliation(s)
- Audrey Dieu
- Department of Anesthesiology, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Philippe Huynen
- Department of Cardiovascular Sciences, KULeuven, Leuven, Belgium
| | - Patricia Lavand'homme
- Department of Anesthesiology, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Hélène Beloeil
- Anesthesia and Intensive Care Department, University of Rennes, CHU Rennes, Inserm, INRA, CIC 1414 NuMeCan, Rennes, France
| | - Stephan M Freys
- Department of Surgery, DIAKO Ev. Diakonie-Krankenhaus, Bremen, Germany
| | - Esther M Pogatzki-Zahn
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Münster, Münster, Germany
| | - Girish P Joshi
- Department of Anesthesiology and Pain Management, University of Texas, Southwestern Medical Center, Dallas, Texas, USA
| | - Marc Van de Velde
- Department of Cardiovascular Sciences, KULeuven, Leuven, Belgium.,Department of Anesthesiology, UZ Leuven, Leuven, Belgium
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Zhang N, Wu G, Zhou Y, Liao Z, Guo J, Liu Y, Huang Q, Li X. Use of Enhanced Recovery After Surgery (ERAS) in Laparoscopic Cholecystectomy (LC) Combined with Laparoscopic Common Bile Duct Exploration (LCBDE): A Cohort Study. Med Sci Monit 2020; 26:e924946. [PMID: 32918441 PMCID: PMC7510172 DOI: 10.12659/msm.924946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The have been few reports on use of ERAS in LC combined with LCBDE to promote postoperative recovery of patients. Therefore, the purpose of this cohort study was to explore the use of ERAS in patients who underwent LC combined with LCBDE. Material/Methods We collected clinical data of 445 patients who underwent elective laparoscopic cholecystectomy combined with laparoscopic common bile duct exploration from January 2015 to February 2019 in our hospital and divided the patients into an E-LC group and an LC group. The stress response index, postoperative complication rate, and postoperative rehabilitation effect of the 2 groups were compared and analyzed. Results The WBC count and CRP levels in the E-LC group were significantly lower than those of the LC group 1 day after surgery (p<0.05). In terms of the postoperative complications, the incidence of nausea, incisional pain, and vomiting in the E-LC group were lower than in the LC group, and the differences were statistically significant (p<0.05). In terms of the postoperative rehabilitation efficacy, flatus time and length of hospital stay after surgery in the E-LC group were significantly shorter than those in the LC group (p<0.05). Conclusions Use of ERAS in the perioperative period in patients who underwent LC combined with LCBDE reduces the stress response and postoperative complications and accelerates postoperative rehabilitation. Clinical trial registration number ChiCTR1900024292, http://www.chictr.org.cn/showprojen.aspx?proj=40785
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Affiliation(s)
- Nannan Zhang
- Department of General Surgery, Baoshan Branch of Huashan North Courtyard Affiliated to Fudan University, (Renhe Hospital, Baoshan District, Shanghai), Shanghai, China (mainland)
| | - Gang Wu
- Department of General Surgery, Baoshan Branch of Huashan North Courtyard Affiliated to Fudan University, (Renhe Hospital, Baoshan District, Shanghai), Shanghai, China (mainland)
| | - Yuanhang Zhou
- Department of General Surgery, Baoshan Branch of Huashan North Courtyard Affiliated to Fudan University, (Renhe Hospital, Baoshan District, Shanghai), Shanghai, China (mainland)
| | - Zhiwei Liao
- Department of General Surgery, Baoshan Branch of Huashan North Courtyard Affiliated to Fudan University, (Renhe Hospital, Baoshan District, Shanghai), Shanghai, China (mainland)
| | - Jinxing Guo
- Department of General Surgery, Baoshan Branch of Huashan North Courtyard Affiliated to Fudan University, (Renhe Hospital, Baoshan District, Shanghai), Shanghai, China (mainland)
| | - Yongjun Liu
- Department of General Surgery, Baoshan Branch of Huashan North Courtyard Affiliated to Fudan University, (Renhe Hospital, Baoshan District, Shanghai), Shanghai, China (mainland)
| | - Qi Huang
- Department of General Surgery, Baoshan Branch of Huashan North Courtyard Affiliated to Fudan University, (Renhe Hospital, Baoshan District, Shanghai), Shanghai, China (mainland)
| | - Xiaodong Li
- Department of General Surgery, Baoshan Branch of Huashan North Courtyard Affiliated to Fudan University, (Renhe Hospital, Baoshan District, Shanghai), Shanghai, China (mainland)
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Giovinazzo F, Kuemmerli C, Moekotte A, Rawashdeh A, Suhool A, Armstrong T, Primrose J, Abu Hilal M. The impact of enhanced recovery on open and laparoscopic liver resections. Updates Surg 2020; 72:649-657. [PMID: 32418169 DOI: 10.1007/s13304-020-00786-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 05/02/2020] [Indexed: 01/11/2023]
Abstract
Enhanced recovery after surgery programs (ERP) have been implemented in many surgical specialties. Their impact in liver surgery is poorly understood and approach-specific ERPs have not yet been assessed. This retrospective study aims to analyse the effect of such programs on liver resection. All patients undergoing liver resection at a tertiary referral centre between January 2009 and April 2019 were identified. Primary outcome was the length of stay (LOS), secondary outcomes were functional recovery, complications and readmission rates. Patients in the ERP with different protocols for open, laparoscopic, major and minor resections were compared to a historical cohort. Of 1056 patients, 644 were treated within the ERP. A comparable duration of hospital stay [7 days (IQR (interquartile range) 6-12) vs 7 days (IQR 5-9) p = 0.047] and faster functional recovery with fewer complications was found in the ERP group [94 (50.5%) vs 103 (35.9%) p < 0.002]. Those advantages were smaller after open minor compared to open major resection. In patients undergoing laparoscopic resection no differences were observed except for a lower readmission rate [21 (9.3%) vs 13 (3.6%) p = 0.005]. Multivariable analysis showed that laparoscopy was associated with a shorter LOS. ERPs offer significant advantages in open liver surgery. Those advantages are less evident after laparoscopic resection.
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Affiliation(s)
- Francesco Giovinazzo
- Department of Surgery, University Hospital of Southampton NHS Foundation Trust, Southampton, UK
| | - Christoph Kuemmerli
- Department of Surgery, University Hospital of Southampton NHS Foundation Trust, Southampton, UK
- Department of Surgery, Istituto Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy
| | - Alma Moekotte
- Department of Surgery, University Hospital of Southampton NHS Foundation Trust, Southampton, UK
| | - Arab Rawashdeh
- Department of Surgery, University Hospital of Southampton NHS Foundation Trust, Southampton, UK
| | - Amal Suhool
- Department of Surgery, University Hospital of Southampton NHS Foundation Trust, Southampton, UK
| | - Thomas Armstrong
- Department of Surgery, University Hospital of Southampton NHS Foundation Trust, Southampton, UK
| | - John Primrose
- Department of Surgery, University Hospital of Southampton NHS Foundation Trust, Southampton, UK
| | - Mohammed Abu Hilal
- Department of Surgery, University Hospital of Southampton NHS Foundation Trust, Southampton, UK.
- Department of Surgery, Istituto Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy.
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25
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Van Beijsterveld CAFM, Bongers BC, Den Dulk M, Van Kuijk SMJ, Dejong CHC, Van Meeteren NLU. Exploring the relation between preoperative physical functioning and the impact of major complications in patients following pancreatic resection. HPB (Oxford) 2020; 22:716-727. [PMID: 31740275 DOI: 10.1016/j.hpb.2019.09.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 09/14/2019] [Accepted: 09/16/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study aimed to evaluate the association between preoperative level of physical functioning and time to recovery of physical functioning, postoperative complications, and the impact of postoperative major complications in patients undergoing elective pancreatic resection. Additionally, prediction models to identify high-risk patients for developing a major complication were externally validated. METHODS Perioperative data of patients who underwent pancreatic resection were analysed. Primary outcomes were time to recovery of physical functioning and postoperative major complications. Impact of a major complication was explored by evaluating its effect on time to recovery of physical functioning. Risk-prediction models were retrieved following a systematic review. RESULTS Multivariable analysis (n = 63) showed that ASA grade III (OR 3.498) and preoperative platelet count (OR 1.005) were associated with major complications, whereas aerobic capacity (OR 0.347) was associated with time to recovery of physical functioning. Age, preoperative aerobic capacity, functional mobility, and perceived level of functional capacity were associated with the impact of a major complication. The AUC of two risk prediction models were 0.556 and 0.701. CONCLUSION Preoperative parameters of physical function were associated with postoperative outcomes and may be useful in outcome prediction, although future approaches should not only register the incidence of major complications but also take the impact of a complication on a patient's physical functioning into account.
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Affiliation(s)
- Christel A F M Van Beijsterveld
- Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands; Department of Physical Therapy, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, the Netherlands.
| | - Bart C Bongers
- Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands; SOMT University of Physiotherapy, PO Box 585, 3800 AN, Amersfoort, the Netherlands; Department of Nutrition and Movement Sciences, Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands
| | - Marcel Den Dulk
- Department of Surgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, the Netherlands; Department of Surgery, University Hospital RWTH-Aachen, 52074, Aachen, Germany
| | - Sander M J Van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, the Netherlands
| | - Cornelius H C Dejong
- Department of Surgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, the Netherlands; Department of Surgery, University Hospital RWTH-Aachen, 52074, Aachen, Germany; Department of Surgery, Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands
| | - Nico L U Van Meeteren
- Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands; Top Sector Life Sciences and Health (Health∼Holland), P.O. Box 93035, 2509 AA, The Hague, the Netherlands
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26
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Liu B, Liu S, Wang Y, Zhao L, Zheng T, Chen L, Zhang Y, Xue Y, Lu D, Ma T, Zhao B, Gao G, Qu Y, He S. Enhanced Recovery After Intraspinal Tumor Surgery: A Single-Institutional Randomized Controlled Study. World Neurosurg 2020; 136:e542-e552. [DOI: 10.1016/j.wneu.2020.01.067] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 01/12/2023]
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27
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Chen H, Jia W. Progress in hepatectomy for hepatocellular carcinoma and peri-operation management. Genes Dis 2020; 7:320-327. [PMID: 32884986 PMCID: PMC7452507 DOI: 10.1016/j.gendis.2020.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/22/2020] [Accepted: 02/06/2020] [Indexed: 12/18/2022] Open
Abstract
The global incidence of liver cancer continues to grow. Liver cancer, especially hepatocellular carcinoma, has high recurrence and mortality rates. Here, we review the past decade's diagnostic, therapeutic, and management strategies for hepatocellular carcinoma, and summarize new patient management approaches, including enhanced recovery after surgery, targeted therapy, and immunotherapy. We compare traditional and innovative management methods, which comprise developments in precision medicine, and consider their limitations. Ongoing innovation and technological advances enable surgeons to gain deeper understandings of the multidimensionality of hepatocellular carcinoma, thereby promoting the continuous development of precision therapy.
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Affiliation(s)
- Hao Chen
- Department of Hepatic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, HeFei, Anhui, 230001, China
- Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, HeFei, Anhui, 230001, China
| | - Weidong Jia
- Department of Hepatic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, HeFei, Anhui, 230001, China
- Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, HeFei, Anhui, 230001, China
- Corresponding author. Department of Hepatic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, HeFei, Anhui, 230001, China. Fax: +86 551 62282121.
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Téoule P, Römling L, Schwarzbach M, Birgin E, Rückert F, Wilhelm TJ, Niedergethmann M, Post S, Rahbari NN, Reißfelder C, Ronellenfitsch U. Clinical Pathways For Pancreatic Surgery: Are They A Suitable Instrument For Process Standardization To Improve Process And Outcome Quality Of Patients Undergoing Distal And Total Pancreatectomy? - A Retrospective Cohort Study. Ther Clin Risk Manag 2019; 15:1141-1152. [PMID: 31632041 PMCID: PMC6778449 DOI: 10.2147/tcrm.s215373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 09/09/2019] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Pancreatic surgery demands complex multidisciplinary management, which is often cumbersome to implement. Clinical pathways (CPs) are a tool to facilitate this task, but evidence for their utility in pancreatic surgery is scarce. This study evaluated if CPs are a suitable tool for process standardization in order to improve process and outcome quality in patients undergoing distal and total pancreatectomy. PATIENTS AND METHODS Data of consecutive patients who underwent distal or total pancreatectomy before (n=67) or after (n=61) CP introduction were evaluated regarding catheter management, postoperative mobilization, pancreatic enzyme substitution, resumption of diet and length of stay. Outcome quality was assessed using glycaemia management, morbidity, mortality, reoperation and readmission rates. RESULTS The usage of incentive spirometers for pneumonia prophylaxis increased. The median number of days with hyperglycemia decreased significantly from 2.5 to 0. For distal pancreatectomy, the incidence of postoperative diabetes dropped from 27.9% to 7.1% (p=0.012). The incidence of postoperative exocrine pancreatic insufficiency decreased from 37.2% to 11.9% (p=0.007). There was no significant difference in mortality, morbidity, reoperation and readmission rates between groups. CONCLUSION Following implementation of a pancreatic surgery CP, several indicators of process and outcome quality improved, while others such as mortality and reoperation rates remained unchanged. CPs are a promising tool to improve quality of care in pancreatic surgery.
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Affiliation(s)
- Patrick Téoule
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim68167, Germany
| | - Laura Römling
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim68167, Germany
| | - Matthias Schwarzbach
- Department of General, Visceral, Vascular, and Thoracic Surgery, Klinikum Frankfurt Höchst, Frankfurt65929, Germany
| | - Emrullah Birgin
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim68167, Germany
| | - Felix Rückert
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim68167, Germany
| | - Torsten J Wilhelm
- Department of General and Visceral Surgery, GRN-Klinik Weinheim, Weinheim69469, Germany
| | | | - Stefan Post
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim68167, Germany
| | - Nuh N Rahbari
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim68167, Germany
| | - Christoph Reißfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim68167, Germany
| | - Ulrich Ronellenfitsch
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle, Halle, Germany
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Quinn L, Mann K, Jones R, Bathla S, Stremitzer S, Dunne D, Lacasia C, Fenwick S, Malik H. Defining enhanced recovery after resection of peri-hilar cholangiocarcinoma. Eur J Surg Oncol 2019; 45:1439-1445. [DOI: 10.1016/j.ejso.2019.03.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/18/2019] [Accepted: 03/25/2019] [Indexed: 12/25/2022] Open
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30
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Cao Y, Gu HY, Huang ZD, Wu YP, Zhang Q, Luo J, Zhang C, Fu Y. Impact of Enhanced Recovery After Surgery on Postoperative Recovery for Pancreaticoduodenectomy: Pooled Analysis of Observational Study. Front Oncol 2019; 9:687. [PMID: 31417868 PMCID: PMC6683725 DOI: 10.3389/fonc.2019.00687] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/12/2019] [Indexed: 12/18/2022] Open
Abstract
Purpose: To assess the impact of enhanced recovery after surgery (ERAS) protocols in pancreaticoduodenectomy. Methods: Four databases were searched for studies describing ERAS program in patients undergoing pancreatic surgery published up to May 01, 2018. Primary outcomes were mortality, readmission, reoperation and postoperative complications. Secondary outcomes were the length of stay and cost. Results: A total of 19 studies met inclusion and exclusion criteria and included 3,387 patients. Meta-analysis showed a decrease in pancreatic fistula (OR = 0.79, 95% CI: 0.67 to 0.95; I 2 = 0%), infection (OR = 0.63, 95% CI: 0.50 to 0.78; I 2 = 0%), especially incision infection (OR = 0.62, 95% CI: 0.42 to 0.91; I 2 = 0%), and pulmonary infection (OR = 0.28, 95% CI: 0.12 to 0.66; I 2 = 0%). Length-of-stay (MD: -3.89 days, 95% CI: -4.98 to -2.81; I 2 = 78%) and cost were also significantly reduced. There was no significant increase in mortality, readmission, reoperation, or delayed gastric emptying. Conclusion: This analysis revealed that using ERAS protocols in pancreatic resections may help decrease the incidence of pancreatic fistula and infections. Furthermore, ERAS also reduces length of stay and cost of care. This study provides evidence for the benefit of ERAS protocols.
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Affiliation(s)
- Yang Cao
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Hui-Yun Gu
- Department of Surgery, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Zhen-Dong Huang
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Ya-Peng Wu
- Department of Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Qiong Zhang
- Department of Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Jie Luo
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Chao Zhang
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Yan Fu
- Department of Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
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31
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Wang Y, Liu B, Zhao T, Zhao B, Yu D, Jiang X, Ye L, Zhao L, Lv W, Zhang Y, Zheng T, Xue Y, Chen L, Sankey E, Chen L, Wu Y, Li M, Ma L, Li Z, Li R, Li J, Yan J, Wang S, Zhao H, Sun X, Gao G, Qu Y, He S. Safety and efficacy of a novel neurosurgical enhanced recovery after surgery protocol for elective craniotomy: a prospective randomized controlled trial. J Neurosurg 2019; 130:1680-1691. [PMID: 29932379 DOI: 10.3171/2018.1.jns171552] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 01/16/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Although enhanced recovery after surgery (ERAS) programs have gained acceptance in various surgical specialties, no established neurosurgical ERAS protocol for patients undergoing elective craniotomy has been reported in the literature. Here, the authors describe the design, implementation, safety, and efficacy of a novel neurosurgical ERAS protocol for elective craniotomy in a tertiary care medical center located in China. METHODS A multidisciplinary neurosurgical ERAS protocol for elective craniotomy was developed based on the best available evidence. A total of 140 patients undergoing elective craniotomy between October 2016 and May 2017 were enrolled in a randomized clinical trial comparing this novel protocol to conventional neurosurgical perioperative management. The primary endpoint of this study was the postoperative hospital length of stay (LOS). Postoperative morbidity, perioperative complications, postoperative pain scores, postoperative nausea and vomiting, duration of urinary catheterization, time to first solid meal, and patient satisfaction were secondary endpoints. RESULTS The median postoperative hospital LOS (4 days) was significantly shorter with the incorporation of the ERAS protocol than that with conventional perioperative management (7 days, p < 0.0001). No 30-day readmission or reoperation occurred in either group. More patients in the ERAS group reported mild pain (visual analog scale score 1-3) on postoperative day 1 than those in the control group (79% vs. 33%, OR 7.49, 95% CI 3.51-15.99, p < 0.0001). Similarly, more patients in the ERAS group had a shortened duration of pain (1-2 days; 53% vs. 17%, OR 0.64, 95% CI 0.29-1.37, p = 0.0001). The urinary catheter was removed within 6 hours after surgery in 74% patients in the ERAS group (OR 400.1, 95% CI 23.56-6796, p < 0.0001). The time to first oral liquid intake was a median of 8 hours in the ERAS group compared to 11 hours in the control group (p < 0.0001), and solid food intake occurred at a median of 24 hours in the ERAS group compared to 72 hours in the control group (p < 0.0001). CONCLUSIONS This multidisciplinary, evidence-based, neurosurgical ERAS protocol for elective craniotomy appears to have significant benefits over conventional perioperative management. Implementation of ERAS is associated with a significant reduction in the postoperative hospital stay and an acceleration in recovery, without increasing complication rates related to elective craniotomy. Further evaluation of this protocol in large multicenter studies is warranted.Clinical trial registration no.: ChiCTR-INR-16009662 (chictr.org.cn).
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Affiliation(s)
| | | | | | | | | | | | - Lin Ye
- 3Nutrition, Tangdu Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China; and
| | | | | | | | | | | | | | - Eric Sankey
- 4Department of Neurosurgery, Duke University Hospital, Durham, North Carolina
| | | | | | | | - Lin Ma
- Departments of1Neurosurgery
| | | | | | | | - Jing Yan
- 3Nutrition, Tangdu Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China; and
| | - Shasha Wang
- 3Nutrition, Tangdu Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China; and
| | | | | | | | - Yan Qu
- Departments of1Neurosurgery
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Teixeira UF, Goldoni MB, Waechter FL, Sampaio JA, Mendes FF, Fontes PRO. ENHANCED RECOVERY (ERAS) AFTER LIVER SURGERY:COMPARATIVE STUDY IN A BRAZILIAN TERCIARY CENTER. ACTA ACUST UNITED AC 2019; 32:e1424. [PMID: 30758472 PMCID: PMC6368150 DOI: 10.1590/0102-672020180001e1424] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/16/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND After the publication of the first recommendations of ERAS Society regarding colonic surgery, the proposal of surgical stress reduction, maintenance of physiological functions and optimized recovery was expanded to other surgical specialties, with minimal variations. AIM To analyze the implementation of ERAS protocols for liver surgery in a tertiary center. METHODS Fifty patients that underwent elective hepatic surgery were retrospectively evaluated, using medical records data, from June 2014 to August 2016. After September 2016, 35 patients were prospectively evaluated and managed in accordance with ERAS protocol. RESULTS There was no difference in age, type of hepatectomy, laparoscopic surgery and postoperative complications between the groups. In ERAS group, it was observed a reduction in preoperative fasting and in the length of hospital stay by two days (p< 0.001). Carbohydrate loading, j-shaped incision, early oral feeding, postoperative prevention of nausea and vomiting and early mobilization were also significantly related to ERAS group. Oral bowel preparation, pre-anesthetic medication, sub-costal incision, prophylactic nasogastric intubation and abdominal drainage were more common in control group. CONCLUSION Implementation of ERAS protocol is feasible and beneficial for health institutions and patients, without increasing morbidity and mortality.
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Affiliation(s)
| | | | | | | | - Florentino Fernandes Mendes
- Department of Anesthesiology, Federal University of Health Sciences of Porto Alegre / Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
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Khalil A, Ganesh S, Hughes C, Tevar AD, Hasche JJ, Esper S, Humar A. Evaluation of the enhanced recovery after surgery protocol in living liver donors. Clin Transplant 2018; 32:e13342. [DOI: 10.1111/ctr.13342] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 05/09/2018] [Accepted: 06/22/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Ahmed Khalil
- Faculty of Medicine; Ain Shams University; Cairo Egypt
| | - Swaytha Ganesh
- University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | | | - Amit D. Tevar
- University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - John J. Hasche
- University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Stephen Esper
- University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Abhinav Humar
- University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
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Donohoe CL, Phillips AW, Flynn E, Donnison C, Taylor CL, Sinclair RCF, Saunders D, Immanuel A, Griffin SM. Multimodal analgesia using intrathecal diamorphine, and paravertebral and rectus sheath catheters are as effective as thoracic epidural for analgesia post-open two-phase esophagectomy within an enhanced recovery program. Dis Esophagus 2018; 31:5003208. [PMID: 29800270 DOI: 10.1093/dote/doy006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Thoracic epidural (TE) analgesia has been the standard of care for transthoracic esophagectomy patients since the 1990s. Multimodal anesthesia using intrathecal diamorphine, local anesthetic infusion catheters (LAC) into the paravertebral space and rectus sheaths and intravenous opioid postoperatively represent an alternative option for postoperative analgesia. While TE can provide excellent pain control, it may inhibit early postoperative recovery by causing hypotension and reducing mobilization. The aim of this study is to determine whether multimodal analgesia with LAC was effective with respect to adequate pain management, and compare its impact on hypotension and mobility. Patients receiving multimodal LAC analgesia were matched using propensity score matching to patients undergoing two-phase trans-thoracic esophagectomy with a TE over a two-year period (from January 2015 to December 2016). Postoperative endpoints that had been evaluated prospectively, including pain scores on movement and at rest, inotrope or vasoconstrictor requirements, and hypotension (systolic BP < 90 mmHg), were compared between cohorts. Out of 14 patients (13 male) that received LAC were matched to a cohort of 14 patients on age, sex, and comorbidity. Mean and maximum pain scores at rest and movement on postoperative days 0 to 3 were equivalent between the groups. In both cohorts, 50% of patients had a pain score of more than 7 on at least one occasion. Fewer patients in the LAC group required vasoconstrictor infusion (LAC: 36% vs. TE: 57%, P = 0.256) to maintain blood pressure or had episodes of hypotension (LAC: 43% vs. TE: 79%, P = 0.05). The LAC group was more able to ambulate on the first postoperative day (LAC: 64% vs. TE: 43%, P = 0.14) but these differences were not statistically significant. Within the epidural cohort, three patients had interruption of epidural due to dislodgement or failure of block compared to no disruption in the multimodal local anesthesia catheters group (P = 0.05). Therefore, multimodal anesthesia using spinal diamorphine with combined paravertebral and rectus sheath local anesthetic catheters appears to provide comparable pain relief post two-phase esophagectomy and may provide more reliable and safe analgesia than the current standard of care.
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Affiliation(s)
- C L Donohoe
- Departments of Surgery, Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - A W Phillips
- Departments of Surgery, Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - E Flynn
- Anaesthesia and Critical Care Medicine, Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - C Donnison
- Anaesthesia and Critical Care Medicine, Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - C L Taylor
- Departments of Surgery, Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - R C F Sinclair
- Anaesthesia and Critical Care Medicine, Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - D Saunders
- Anaesthesia and Critical Care Medicine, Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - A Immanuel
- Departments of Surgery, Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - S M Griffin
- Departments of Surgery, Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
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Burgess LC, Immins T, Wainwright TW. What is the role of post-operative physiotherapy in general surgical Enhanced Recovery after Surgery pathways? EUROPEAN JOURNAL OF PHYSIOTHERAPY 2018. [DOI: 10.1080/21679169.2018.1468813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Louise C. Burgess
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, UK
| | - Tikki Immins
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, UK
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Quinn LM, Dunne DFJ, Jones RP, Poston GJ, Malik HZ, Fenwick SW. Optimal perioperative care in peri-hilar cholangiocarcinoma resection. Eur Surg 2018; 50:93-99. [PMID: 29875797 PMCID: PMC5968056 DOI: 10.1007/s10353-018-0529-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/09/2018] [Indexed: 12/24/2022]
Abstract
Surgical resection remains the only proven curative treatment for peri-hilar cholangiocarcinoma. Despite recent advances in liver surgery techniques and perioperative care, resection for peri-hilar cholangiocarcinoma remains associated with significant morbidity and mortality. Considerable variation in the perioperative management of these patients exists. Optimal perioperative management has the potential to deliver improved outcomes. This article seeks to summarize the evidence underpinning best practice in the perioperative care of patients undergoing resection of peri-hilar cholangiocarcinoma. The authors also seek to identify areas where research efforts and future clinical trials should be targeted.
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Affiliation(s)
- Leonard M. Quinn
- Liverpool Hepatobiliary Centre, Aintree University Hospital, Longmoor Lane, L9 7AL Liverpool, UK
- Institute of translational Medicine, University of Liverpool, Ashton Street, L69 3GE Liverpool, UK
| | - Declan F. J. Dunne
- Liverpool Hepatobiliary Centre, Aintree University Hospital, Longmoor Lane, L9 7AL Liverpool, UK
| | - Robert P. Jones
- Liverpool Hepatobiliary Centre, Aintree University Hospital, Longmoor Lane, L9 7AL Liverpool, UK
| | - Graeme J. Poston
- Liverpool Hepatobiliary Centre, Aintree University Hospital, Longmoor Lane, L9 7AL Liverpool, UK
| | - Hassan Z. Malik
- Liverpool Hepatobiliary Centre, Aintree University Hospital, Longmoor Lane, L9 7AL Liverpool, UK
| | - Stephen W. Fenwick
- Liverpool Hepatobiliary Centre, Aintree University Hospital, Longmoor Lane, L9 7AL Liverpool, UK
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Tufo A, Dunne DFJ, Manu N, Joshi H, Lacasia C, Jones L, Malik HZ, Poston GJ, Fenwick SW. Hepatectomy for octogenarians with colorectal liver metastasis in the era of enhanced recovery. Eur J Surg Oncol 2018; 44:1040-1047. [PMID: 29456045 DOI: 10.1016/j.ejso.2018.01.089] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 12/20/2017] [Accepted: 01/16/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Concern exists regarding the use of hepatectomy to treat colorectal liver metastasis (CRLM) in octogenarians due to prior studies suggesting elevated morbidity and mortality. Cardiopulmonary exercise testing (CPET) within pre-operative assessment and enhanced recovery after surgery (ERAS) have both been shown to be associated with low morbidity and mortality in patients undergoing hepatectomy. This study sought to compare the outcomes of octogenarians with patients aged 70-79 undergoing hepatectomy for CRLM, within a center utilizing both CPET and ERAS. METHODS Consecutive patients age 70 or older who underwent hepatectomy for CRLM at Aintree University Hospital (Liverpool,UK), between May 2008 and May 2015 were identified from a prospectively maintained cancer database. Data were extracted and comparisons drawn. RESULTS 127 patients aged 70-79 years and 34 octogenarians underwent respectively 137 and 35 hepatectomy for CRLM. There was no difference in hospital stay (6 days), morbidity and mortality between the groups. OS at 1, 3 and 5 years were 86.7%, 55% and 35.8% for those aged 70-79 compared to 79.4%, 37.3% and 20.4% for the octogenarians (p=0.127). DFS at 1,3 and 5 years was 52.5%, 31.7% and 31.7% for 70-79 group compared to 46.2%, 31.5% and 16.8% for the octogenarians (p=0.838). On multivariate analysis major hepatectomy was associated with an increased risk of post-operative complications, inferior OS and DFS. Chronological age was not a predictor of postoperative complications, poorer OS or DFS. CONCLUSIONS Appropriately selected octogenarians can have similar postoperative outcomes to patients aged 70-79 when undergoing hepatectomy for CRLM using ERAS combined with CPET. This study advocates using CPET and ERAS in the selection and management of octogenarian patients with CRLM undergoing hepatectomy.
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Affiliation(s)
- Andrea Tufo
- Liverpool Hepatobiliary Centre, University Hospital Aintree, Longmoor Lane, Liverpool, L9 7AL, UK.
| | - Declan F J Dunne
- Liverpool Hepatobiliary Centre, University Hospital Aintree, Longmoor Lane, Liverpool, L9 7AL, UK
| | - Nichola Manu
- Liverpool Hepatobiliary Centre, University Hospital Aintree, Longmoor Lane, Liverpool, L9 7AL, UK
| | - Heman Joshi
- Liverpool Hepatobiliary Centre, University Hospital Aintree, Longmoor Lane, Liverpool, L9 7AL, UK
| | - Carmen Lacasia
- Liverpool Hepatobiliary Centre, University Hospital Aintree, Longmoor Lane, Liverpool, L9 7AL, UK
| | - Louise Jones
- Liverpool Hepatobiliary Centre, University Hospital Aintree, Longmoor Lane, Liverpool, L9 7AL, UK
| | - Hassan Z Malik
- Liverpool Hepatobiliary Centre, University Hospital Aintree, Longmoor Lane, Liverpool, L9 7AL, UK
| | - Graeme J Poston
- Liverpool Hepatobiliary Centre, University Hospital Aintree, Longmoor Lane, Liverpool, L9 7AL, UK
| | - Stephen W Fenwick
- Liverpool Hepatobiliary Centre, University Hospital Aintree, Longmoor Lane, Liverpool, L9 7AL, UK
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Slim K, Joris J. The egg-and-chicken situation in postoperative enhanced recovery programmes. Br J Anaesth 2017; 118:5-6. [DOI: 10.1093/bja/aew408] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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