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Kuznicki ML, Yasukawa M, Mallen AR, Lam C, Eggers E, Regis J, Wells A, Todd SL, Robertson SE, Tanner JP, Anderson ML, Rutherford TJ. Feasibility and safety of planned early discharge following laparotomy in gynecologic oncology with enhanced recovery protocol including opioid-sparing anesthesia. Front Surg 2023; 10:1279907. [PMID: 38026485 PMCID: PMC10654978 DOI: 10.3389/fsurg.2023.1279907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/03/2023] [Indexed: 12/01/2023] Open
Abstract
Objective This study aims to evaluate the feasibility and safety of planned postoperative day 1 discharge (PPOD1) among patients who undergo laparotomy (XL) in the department of gynecology oncology utilizing a modified enhanced recovery after surgery (ERAS) protocol including opioid-sparing anesthesia (OSA) and defined discharge criteria. Methods Patients undergoing XL and minimally invasive surgery (MIS) were enrolled in this prospective, observational cohort study after the departmental implementation of a modified ERAS protocol. The primary outcome was quality of life (QoL) using SF36, PROMIS GI, and ICIQ-FLUTS at baseline and 2- and 6-week postoperative visits. Statistical significance was assessed using the two-tailed Student's t-test and non-parametric Mann-Whitney two-sample test. Results Of the 141 subjects, no significant demographic differences were observed between the XL group and the MIS group. The majority of subjects, 84.7% (61), in the XL group had gynecologic malignancy [vs. MIS group; 21 (29.2%), p < 0.001]. All patients tolerated OSA. The XL group required higher intraoperative opioids [7.1 ± 9.2 morphine milligram equivalents (MME) vs. 3.9 ± 6.9 MME, p = 0.02] and longer surgical time (114.2 ± 41 min vs. 96.8 ± 32.1 min, p = 0.006). No significant difference was noted in the opioid requirements at the immediate postoperative phase and the rest of the postoperative day (POD) 0 or POD 1. In the XL group, 69 patients (73.6%) were successfully discharged home on POD1. There was no increase in the PROMIS score at 2 and 6 weeks compared to the preoperative phase. The readmission rates within 30 days after surgery (XL 4.2% vs. MIS 1.4%, p = 0.62), rates of surgical site infection (XL 0% vs. MIS 2.8%, p = 0.24), and mean number of post-discharge phone calls (0 vs. 0, p = 0.41) were comparable between the two groups. Although QoL scores were significantly lower than baseline in four of the nine QoL domains at 2 weeks post-laparotomy, all except physical health recovered by the 6-week time point. Conclusions PPOD1 is a safe and feasible strategy for XL performed in the gynecologic oncology department. PPOD1 did not increase opioid requirements, readmission rates compared to MIS, and patient-reported constipation and nausea/vomiting compared to the preoperative phase.
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Affiliation(s)
- Michelle L. Kuznicki
- Division of Obstetrics & Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, United States
- Women’s Health Institute, The Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Maya Yasukawa
- Division of Obstetrics & Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, United States
| | - Adrianne R. Mallen
- Division of Obstetrics & Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, United States
- Department of Gynecology Oncology, Park Nicollet Methodist Hospital, Saint Louis Park, MN, United States
| | - Clarissa Lam
- Division of Obstetrics & Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, United States
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Center, New York, NY, United States
| | - Erica Eggers
- Division of Obstetrics & Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, United States
- Department of Urogynecology, Cooper University Health Care, Camden, NJ, United States
| | - Jefferson Regis
- Division of Obstetrics & Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, United States
- School of Medicine, St. George’s University School of Medicine, Great River, NY, United States
| | - Ali Wells
- Division of Obstetrics & Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, United States
- Department of Internal Medicine, University of Florida, Gainesville, FL, United States
| | - Sarah L. Todd
- Division of Obstetrics & Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, United States
- Division of Gynecologic Oncology, University of Louisville School of Medicine, Louisville, KY, United States
| | - Sharon E. Robertson
- Division of Obstetrics & Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, United States
- Division of Gynecologic Oncology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Jean-Paul Tanner
- Department of Community and Family Health, University of South Florida College of Public Health, Tampa, FL, United States
| | - Matthew L. Anderson
- Division of Obstetrics & Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, United States
| | - Thomas J. Rutherford
- Division of Obstetrics & Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, United States
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Vujović KS, Vučković S, Stojanović R, Divac N, Medić B, Vujović A, Srebro D, Prostran M. Interactions between Ketamine and Magnesium for the Treatment of Pain: Current State of the Art. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2022; 20:392-400. [PMID: 33475079 DOI: 10.2174/1871527320666210121144216] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/20/2020] [Accepted: 09/11/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Over the past three decades, NMDA-receptor antagonists have been shown to be efficient drugs for treating pain, particularly pain resistant to conventional analgesics. Emphasis will be on the old-new drugs, ketamine and magnesium, and their combination as a novel approach for treating chronic pain. METHODS The MEDLINE database was searched via PubMed for articles that were published up to March 1, 2020, with the keywords 'ketamine', 'magnesium', and 'pain' (in the title/abstract). RESULTS Studies in animals, as well as humans, have shown that interactions of ketamine and magnesium can be additive, antagonistic, and synergistic. These discrepancies might be due to differences in magnesium and ketamine dosage, administration times, and the chronological order of drug administration. Different kinds of pain can also be the source of divergent results. CONCLUSION This review explains why studies performed with a combination of ketamine and magnesium have given inconsistent results. Because of the lack of efficacy of drugs available for pain, ketamine and magnesium in combination provide a novel therapeutic approach that needs to be standardized with a suitable dosing regimen, including the chronological order of drug administration.
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Affiliation(s)
- Katarina S Vujović
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sonja Vučković
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Radan Stojanović
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nevena Divac
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Branislava Medić
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Dragana Srebro
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milica Prostran
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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