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Yadav K, Prakash R, Singh GP, Gautam S, Arshad Z, Singh BP. Effect of Carbohydrate Loading in Diabetic Patients Undergoing Laparoscopic Cholecystectomy: A Randomized Controlled Trial. Cureus 2023; 15:e44570. [PMID: 37790019 PMCID: PMC10544875 DOI: 10.7759/cureus.44570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2023] [Indexed: 10/05/2023] Open
Abstract
INTRODUCTION Investigations of preoperative oral carbohydrate (CHO) loading have primarily examined benefits among patients without diabetes. Preoperative CHO-rich beverages in general populations have resulted in reductions in insulin resistance after surgery, protein loss, metabolic derangements, and immune dysfunction. The aim of this study was to assess the effect of CHO loading in diabetic patients undergoing laparoscopic cholecystectomy. METHODS Diabetic patients controlled on oral hypoglycemic agent were randomly divided into two groups: (1) Group T - this group will be given 50 g of maltodextrin before two hours of surgery; (2) Group C - this group will be kept nil per oral as per standard protocol. Blood sugar, serum insulin, serum cortisol, and insulin requirement were compared in both groups. RESULTS Blood sugar levels of Group C were found to be significantly higher than that of Group T at six hours and 24 hours. In Group T, a rise in baseline serum insulin (8.94 ± 3.43 mIU/l) was observed at 24 hours (13.23 ± 5.71 mIU/l). A change of 4.29 ± 3.00 mIU/l in serum insulin level was observed. The change in baseline serum insulin levels was 47.99%. In Group C too, a rise in baseline serum insulin (6.27 ± 1.74 mIU/l) was observed at 24 hours (18.00 ± 5.34 mIU/l). A change of 11.73 ± 4.97 mIU/l in serum insulin level was observed. The change in baseline HOMA-IR (homeostatic model assessment for insulin resistance) levels in Group T was 53.66%. A rise (4.39 ± 1.63) in baseline HOMA-IR of Group C (1.65 ± 0.45) was observed at 24 hours (6.04 ± 1.76). The change in baseline HOMA-IR levels in Group C was 266.06%. CONCLUSIONS CHO loading is observed to be beneficial in diabetic patients undergoing laparoscopic cholecystectomy. No adverse effects or an increased risk of aspiration were observed in the intervention group during the study period.
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Affiliation(s)
- Kavita Yadav
- Anesthesiology, King George's Medical University, Lucknow, IND
| | - Ravi Prakash
- Anesthesiology, King George's Medical University, Lucknow, IND
| | | | - Shefali Gautam
- Anesthesiology, King George's Medical University, Lucknow, IND
| | - Zia Arshad
- Anesthesiology, King George's Medical University, Lucknow, IND
| | - Brijesh P Singh
- Anesthesiology, King George's Medical University, Lucknow, IND
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Dahiya D, Nigam PS. Nutraceutical Combinational Therapy for Diarrhoea Control with Probiotic Beverages from Fermented Fruits, Vegetables and Cereals to Regain Lost Hydration, Nutrition and Gut Microbiota. Microorganisms 2023; 11:2190. [PMID: 37764034 PMCID: PMC10537194 DOI: 10.3390/microorganisms11092190] [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: 07/13/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
This article deals with the condition of irregular bowel movements known as diarrhoea, its pathology, symptoms and aetiology. The information has been presented on causes of diarrhoea that include gut infections, food intolerances and allergies to certain ingredients, problems in the gastrointestinal tract like irritable bowel syndrome, inflammatory bowel disease and, the condition of dysbiosis which occurs due to long-term use of antibiotics, or other medicines, etc. Most cases of diarrhoea can be resolved without needing medical treatment; however, it is still important to avoid dehydration of the body and use some supplements to get necessary nutrients which are lost with frequent bowel movements before they can get absorbed and assimilated in the gastrointestinal tract. Probiotic products are reported as natural therapeutic agents, which can reduce the risk of diarrhoea in both adults and children. The intake of dietary fluid supplements in the form of fermented beverages containing probiotic strains could help in diarrhoea control. The patient would achieve benefits with the consumption of these functional beverages in three ways-by regaining lost fluids to the body, supplementing beneficial gut bacteria to restore diversity in gut microbiota, which was disturbed in the condition of diarrhoea as well as regaining a source of quick nutrition to recoup energy.
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Affiliation(s)
| | - Poonam Singh Nigam
- Biomedical Sciences Research Institute, Ulster University, Coleraine BT52 1SA, UK
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Ioannidis O, Chatzakis C, Tirta M, Anestiadou E, Zapsalis K, Symeonidis S, Bitsianis S, Kotidis E, Pramateftakis MG, Mantzoros I, Angelopoulos S. The Efficacy of Probiotics, Prebiotics, and Synbiotics in Patients Who Have Undergone Abdominal Operation, in Terms of Bowel Function Post-Operatively: A Network Meta-Analysis. J Clin Med 2023; 12:4150. [PMID: 37373843 DOI: 10.3390/jcm12124150] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/14/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Abdominal operations may lead to post-operative bowel dysfunction, while administration of probiotics, prebiotics and synbiotics may limit its manifestation. Τhe study aimed to assess the efficacy of probiotics, prebiotics and synbiotics in patients who undergone abdominal operation, in terms of bowel function post-operatively. METHODS PubMed, Scopus, Cochrane Central Register of Controlled Trials (Central), Embase, US Registry of clinical trials, and sources of grey literature were searched. The relative effect sizes were estimated, and we obtained the relative ranking of the interventions using cumulative ranking curves. RESULTS In total, 30 studies were included in the analysis. For the outcome of post-operative ileus, probiotics was superior to placebo/no intervention (relative risk, RR: 0.38; 95%CI: 0.14-0.98) with the highest SUCRA (surface under the cumulative ranking) value (92.1%). For time to first flatus, probiotics (MD: -0.47; 95%CI: -0.78 to -0.17) and synbiotics (MD: -0.53; 95%CI: -0.96 to -0.09) were superior to placebo/no intervention. For time to first defecation and for post-operative abdominal distension probiotics were superior to placebo/no intervention. For post-operative hospitalization days, synbiotics were superior to placebo/no intervention (MD: -3.07; 95%CI: -4.80 to -1.34). CONCLUSIONS Administration of probiotics in patients who had undergone abdominal surgery reduced the prevalence of post-operative ileus, time to first flatus, time to first defecation, and prevalence of post-operative abdominal distension. Synbiotics reduce time to first flatus and post-operative hospitalization days.
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Affiliation(s)
- Orestis Ioannidis
- Fourth Surgical Department, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Christos Chatzakis
- Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Maria Tirta
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Elissavet Anestiadou
- Fourth Surgical Department, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Konstantinos Zapsalis
- Fourth Surgical Department, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Savvas Symeonidis
- Fourth Surgical Department, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Stefanos Bitsianis
- Fourth Surgical Department, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Efstathios Kotidis
- Fourth Surgical Department, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | | | - Ioannis Mantzoros
- Fourth Surgical Department, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Stamatios Angelopoulos
- Fourth Surgical Department, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
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Ketelaers SHJ, Dhondt L, van Ham N, Harms AS, Scholten HJ, Nieuwenhuijzen GAP, Rutten HJT, Burger JWA, Bloemen JG, Vogelaar FJ. A prospective cohort study to evaluate continuous wound infusion with local analgesics within an enhanced recovery protocol after colorectal cancer surgery. Colorectal Dis 2022; 24:1172-1183. [PMID: 35637573 DOI: 10.1111/codi.16201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/29/2022] [Accepted: 05/22/2022] [Indexed: 02/08/2023]
Abstract
AIM To reduce detrimental opioid-related side effects, minimising the postoperative opioid consumption is needed, especially in older patients. Continuous wound infusion (CWI) with local analgesics appears to be an effective opioid-sparing alternative. However, the added value of CWI to an enhanced recovery protocol after colorectal cancer (CRC) surgery is unclear. The aim of this study was to evaluate the outcomes of CWI after CRC surgery within a strictly adhered to enhanced recovery protocol. METHODS In this multicentre prospective observational cohort study, patients who underwent CRC surgery between May 2019 and January 2021 were included. Patients were treated with CWI as adjunct to multimodal pain management within an enhanced recovery protocol. Postoperative opioid consumption, pain scores and outcomes regarding functional recovery were evaluated. RESULTS A cohort of 130 consecutive patients were included, of whom 36.2% were ≥75 years. Postoperative opioids were consumed by 80 (61.5%) patients on postoperative day 0, and by 28 (21.5%), 27 (20.8%), and 18 (13.8%) patients on postoperative days 1, 2, and 3, respectively. Median pain scores were <4 on all days. The median time until first passage of stool was 1.0 (IQR: 1.0-2.0) day. Postoperative delirium occurred in 0.8%. Median length of hospital stay was 3.0 days (IQR: 2.0-5.0). CONCLUSION In patients treated with CWI, low amounts of postoperative opioid consumption, adequate postoperative pain control, and enhanced recovery were observed. CWI seems a beneficial opioid-sparing alternative and may further improve the outcomes of an enhanced recovery protocol after CRC surgery, which seems especially valuable for older patients.
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Affiliation(s)
| | - Lieke Dhondt
- Department of Surgery, VieCuri Medical Centre, Venlo, The Netherlands
| | - Nikki van Ham
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Ansgar S Harms
- Department of Anaesthesiology, VieCuri Medical Centre, Venlo, The Netherlands
| | - Harm J Scholten
- Department of Anaesthesiology, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Harm J T Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.,GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | | | - Johanne G Bloemen
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - F Jeroen Vogelaar
- Department of Surgery, VieCuri Medical Centre, Venlo, The Netherlands.,GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
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Our experience in perioperative medicine in patients with colorectal surgery. JOURNAL OF CONTEMPORARY MEDICINE 2021. [DOI: 10.16899/jcm.707639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Dai Y, Jiang R, Su W, Wang M, Liu Y, Zuo Y. Impact of perioperative intravenous lidocaine infusion on postoperative pain and rapid recovery of patients undergoing gastrointestinal tumor surgery: a randomized, double-blind trial. J Gastrointest Oncol 2020; 11:1274-1282. [PMID: 33457000 DOI: 10.21037/jgo-20-505] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background To explore the effect of perioperative intravenous lidocaine infusion on postoperative pain and the rapid recovery of patients undergoing gastrointestinal tumor surgery. Methods The patients who underwent gastrointestinal tumor surgery from May to July 2020 were selected. The patients were randomly divided into the lidocaine group (group L) and control group (group C) by the random number table method, with 60 patients in each group. Both groups of patients received an intravenous drug infusion immediately after induction of tracheal intubation under general anesthesia. In group L, 1.5 mg/kg lidocaine was slowly injected intravenously at a rate of 1.5 mg·kg-1·h-1 to the surgical suture, and intravenous inhalation was used to maintain the depth of anesthesia. Group C patients were given the same volume of normal saline. The 2-, 4-, 7-, 14-, 30-, and 90-day numerical rating scale (NRS) and the proportion of chronic post-surgical pain (CPSP) after 3 months for both groups after surgery were recorded. Each patient's postoperative comfort score, requiring analgesia, return of flatus, bowl movement, hospitalization days, hospitalization expenses, and adverse events were also recorded. Results One hundred and twenty patients were enrolled but 5 of them failed to complete the treatment process. Therefore, 58 and 57 patients in group L and C were included into the final analysis. The NRS of patients in group L was significantly lower than that of group C at all time points after surgery (P<0.05), and the proportion of CPSP in group L was significantly lower than that of group C (P<0.05). The percentage of patients requiring analgesia and postoperative comfort score of group L was significantly higher than that of group C (P<0.01), patient's return of flatus, bowl movement, hospitalization days, and hospitalization expenses in group L were significantly lower than those in group C (P<0.05). There were no difference of adverse events between the 2 groups (P>0.05). Conclusions During the perioperative period of radical gastrointestinal tumor surgery, intravenous lidocaine infusion can reduce acute postoperative pain, promote postoperative gastrointestinal function recovery, and improve postoperative comfort.
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Affiliation(s)
- Yue'e Dai
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.,Department of Anesthesiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Rong Jiang
- Department of Anesthesiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Wenjie Su
- Department of Anesthesiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Man Wang
- Department of Anesthesiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yue Liu
- Department of Anesthesiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yunxia Zuo
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
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Talutis SD, Lee SY, Cheng D, Rosenkranz P, Alexanian SM, McAneny D. The impact of preoperative carbohydrate loading on patients with type II diabetes in an enhanced recovery after surgery protocol. Am J Surg 2020; 220:999-1003. [DOI: 10.1016/j.amjsurg.2020.03.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 01/31/2023]
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Slim K, Reymond T, Joris J, Paul S, Pereira B, Cotte E. Intolerance to early oral feeding in enhanced recovery after colorectal surgery: an early red flag? Colorectal Dis 2020; 22:95-101. [PMID: 31332910 DOI: 10.1111/codi.14785] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/27/2019] [Indexed: 12/12/2022]
Abstract
AIM Enhanced recovery programmes (ERPs) involve early postoperative oral feeding. The aim of this study was to test the hypothesis that intolerance to early feeding was associated with a complicated postoperative course. METHOD A retrospective cohort analysis of the prospective multicentre database developed by the Francophone Group for Enhanced Recovery after Surgery (GRACE) was undertaken. Seventy-one centres in Belgium, France and Switzerland participated in the study. All patients were encouraged to eat within 24 h after surgery. Patients were separated into two groups according to whether early feeding was well tolerated (WT) or poorly tolerated (PT). The primary outcome measure was overall postoperative complications. Secondary outcome measures were unplanned reoperation, early mobilization rate and duration of postoperative hospital stay. RESULTS Among the cohort of 3034 patients, early feeding was WT in 2614 patients (WT group) and PT in 420 patients (PT group). There were significantly more postoperative complications in the PT group than in the WT group (52.1% vs 17.0%, respectively; P = 0.001), namely more unplanned reoperations, less early mobilization and longer postoperative hospital stay. Multivariate analyses confirmed that PT early feeding was the main and dominant independent factor for postoperative complications [OR 4.47 (95% CI3.49-5.72); P < 0.001], more unplanned reoperations and longer hospital stay. CONCLUSIONS This study demonstrates a close relationship between intolerance to early feeding and a complicated postoperative course. Whenever this simple very early red flag is observed, discharge should not be planned until postoperative complications have been ruled out.
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Affiliation(s)
- K Slim
- Department of Digestive Surgery, University Hospital (CHU), Clermont-Ferrand, France.,Francophone Group for Enhanced Recovery after Surgery (GRACE), Beaumont, France
| | - T Reymond
- Department of Anaesthesia and Critical Care, University Hospital (CHU), Clermont-Ferrand, France
| | - J Joris
- Francophone Group for Enhanced Recovery after Surgery (GRACE), Beaumont, France.,Department of Anaesthesia, University Hospital, Liege, Belgium
| | - S Paul
- Department of Anaesthesia and Critical Care, University Hospital (CHU), Clermont-Ferrand, France
| | - B Pereira
- Biostatistics Unit, Clinical Research and Innovation Department, University Hospital (CHU) of Clermont-Ferrand, Clermont-Ferrand, France
| | - E Cotte
- Department of Colorectal Surgery, University Hospital (CHU), Lyon, France
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Mc Loughlin S, Terrasa S, Ljungqvist O, Sanchez G, Garcia Fornari G, Alvarez A. Nausea and vomiting in a colorectal ERAS program: Impact on nutritional recovery and the length of hospital stay. Clin Nutr ESPEN 2019; 34:73-80. [DOI: 10.1016/j.clnesp.2019.08.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/22/2019] [Accepted: 08/26/2019] [Indexed: 02/06/2023]
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10
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Holder-Murray J, Esper SA, Boisen ML, Gealey J, Meister K, Medich DS, Subramaniam K. Postoperative nausea and vomiting in patients undergoing colorectal surgery within an institutional enhanced recovery after surgery protocol: comparison of two prophylactic antiemetic regimens. Korean J Anesthesiol 2019; 72:344-350. [PMID: 31096730 PMCID: PMC6676025 DOI: 10.4097/kja.d.18.00355] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 05/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Enhanced recovery protocols (ERP) provide optimal perioperative care for surgical patients. Postoperative nausea and vomiting (PONV) is common after colorectal surgery (CRS). We aim to compare the efficacy of aprepitant to a cost-effective alternative, perphenazine, as components of triple antiemetic prophylaxis in ERP patients. METHODS Patients who underwent ERP CRS at a single institution from July 2015 to July 2017 were evaluated retrospectively. Only subjects who received aprepitant (Group 1) or perphenazine (Group 2) preoperatively for PONV prophylaxis were included. Patient characteristics, simplified Apfel PONV scores, perioperative medications, and PONV incidence were compared between the groups. PONV was defined as the need for rescue antiemetics on postoperative days (POD) 0-5. RESULTS Five hundred ninety-seven patients underwent CRS of which 498 met the inclusion criteria. Two hundred thirty-one (46.4%) received aprepitant and 267 (53.6%) received perphenazine. The incidence of early PONV (POD 0-1) was comparable between the two groups: 44.2% in Group 1 and 44.6% in Group 2 (P = 0.926). Late PONV (POD 2-5) occurred less often in Group 1 than Group 2, respectively (35.9% vs. 45.7%, P = 0.027). After matching the groups for preoperative, procedural, and anesthesia characteristics (164 pairs), no difference in early or late PONV could be demonstrated between the groups. CONCLUSIONS The incidence of PONV remains high despite most patients receiving three prophylactic antiemetic medications. Perphenazine can be considered a cost-effective alternative to oral aprepitant for prophylaxis of PONV in patients undergoing CRS within an ERP.
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Affiliation(s)
| | - Stephen A Esper
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Michael L Boisen
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Julie Gealey
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Katie Meister
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David S Medich
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kathirvel Subramaniam
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Su'a B, Hill AG. Opiates in Enhanced Recovery After Surgery: still not convinced. ANZ J Surg 2015; 85:795. [PMID: 26498562 DOI: 10.1111/ans.13289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Bruce Su'a
- Department of Surgery, The University of Auckland, Middlemore Hospital, Auckland, New Zealand
| | - Andrew G Hill
- Department of Surgery, The University of Auckland, Middlemore Hospital, Auckland, New Zealand
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