1
|
Bellantonio D, Bolondi G, Cultrera F, Lofrese G, Mongardi L, Gobbi L, Sica A, Bergamini C, Viola L, Tognù A, Tosatto L, Russo E, Santonastaso DP, Agnoletti V. Erector spinae plane block for perioperative pain management in neurosurgical lower-thoracic and lumbar spinal fusion: a single-centre prospective randomised controlled trial. BMC Anesthesiol 2023; 23:187. [PMID: 37254058 DOI: 10.1186/s12871-023-02130-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 05/09/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Erector spinae plane block is a locoregional anaesthetic technique widely used in several different surgeries due to its safety and efficacy. The aim of this study is to assess its utility in spinal degenerative and traumatic surgery in western countries and for patients of Caucasian ethnicity. METHODS Patients undergoing elective lower-thoracic and lumbar spinal fusion were randomised into two groups: the case group (n = 15) who received erector spinae plane block (ropivacaine 0.4% + dexamethasone 4 mg, 20 mL per side at the level of surgery) plus postoperative opioid analgesia, and the control group (n = 15) who received opioid-based analgesia. RESULTS The erector spinae plane block group showed significantly lower morphine consumption at 48 h postoperatively, lower need for intraoperative fentanyl (203.3 ± 121.7 micrograms vs. 322.0 ± 148.2 micrograms, p-value = 0.021), lower NRS score at 2, 6, 12, 24, and 36 h, and higher satisfaction rates of patients (8.4 ± 1.2 vs. 6.0 ± 1.05, p-value < 0.0001). No differences in the duration of the hospitalisation were observed. No erector spinae plane block-related complications were observed. CONCLUSIONS Erector spinae plane block is a safe and efficient opioid-sparing technique for postoperative pain control after spinal fusion surgery. This study recommends its implementation in everyday practice and incorporation as a part of multimodal analgesia protocols. TRIAL REGISTRATION The study was approved by the local ethical committee of Romagna (CEROM) and registered on ClinicalTrials.gov (NCT04729049). It also adheres to the principles outlined in the Declaration of Helsinki and the CONSORT 2010 guidelines.
Collapse
Affiliation(s)
- Daniele Bellantonio
- Anesthesia Unit - Ospedale Bufalini, viale Ghirotti 286, Cesena, FC, 47521, Italy
| | - Giuliano Bolondi
- Anesthesia Unit - Ospedale Bufalini, viale Ghirotti 286, Cesena, FC, 47521, Italy.
| | - Francesco Cultrera
- Neurosurgery Unit - Ospedale Bufalini, viale Ghirotti 286, Cesena, 47521, Italy
| | - Giorgio Lofrese
- Neurosurgery Unit - Ospedale Bufalini, viale Ghirotti 286, Cesena, 47521, Italy
| | - Lorenzo Mongardi
- Neurosurgery Unit - Ospedale Bufalini, viale Ghirotti 286, Cesena, 47521, Italy
| | - Luca Gobbi
- Anesthesia Unit - Ospedale Bufalini, viale Ghirotti 286, Cesena, FC, 47521, Italy
| | - Andrea Sica
- Anesthesia Unit - Ospedale Bufalini, viale Ghirotti 286, Cesena, FC, 47521, Italy
| | - Carlo Bergamini
- Anesthesia Unit - Ospedale Bufalini, viale Ghirotti 286, Cesena, FC, 47521, Italy
| | - Lorenzo Viola
- Anesthesia Unit - Ospedale Bufalini, viale Ghirotti 286, Cesena, FC, 47521, Italy
| | - Andrea Tognù
- Anesthesia Unit, Istituto Ortopedico Rizzoli, Via Nazionale Ponente 5, Argenta, FE, 44011, Italy
| | - Luigino Tosatto
- Neurosurgery Unit - Ospedale Bufalini, viale Ghirotti 286, Cesena, 47521, Italy
| | - Emanuele Russo
- Anesthesia Unit - Ospedale Bufalini, viale Ghirotti 286, Cesena, FC, 47521, Italy
| | | | - Vanni Agnoletti
- Anesthesia Unit - Ospedale Bufalini, viale Ghirotti 286, Cesena, FC, 47521, Italy
| |
Collapse
|
2
|
Li S, Bercow AS, Falzone M, Kalyanaraman R, Worley MJ, Feltmate CM, Pelletier A, Elias KM. Risk of venous thromboembolism for ovarian cancer patients during first-line therapy after implementation of an Enhanced Recovery After Surgery (ERAS) protocol. Gynecol Oncol 2021; 162:353-359. [PMID: 34092412 DOI: 10.1016/j.ygyno.2021.05.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine incidence and risk factors for VTE for patients with advanced epithelial ovarian cancer undergoing first-line therapy, including cytoreductive surgery, on an Enhanced Recovery After Surgery (ERAS) protocol. METHODS Medical records were reviewed for patients with FIGO stage IIIA-IVB epithelial ovarian, fallopian tube, or primary peritoneal cancer undergoing primary or interval cytoreductive surgery from March 2017 through September 2019. All patients were enrolled on an ERAS protocol, including 28-day postoperative VTE prophylaxis. Demographic information, medical history, perioperative characteristics, and ERAS compliance were evaluated using univariate and multivariate models. RESULTS Of 230 patients undergoing cytoreductive surgery via laparotomy, 155 received neoadjuvant chemotherapy and 75 received primary cytoreduction. 38 patients had a VTE during the study period. 13 events (5.7%) were identified at time of diagnosis, 6 (3.9%) during neoadjuvant chemotherapy, 5 (2.2%) within 30 days after surgery, 5 (2.2%) between 30 days and 6 months after surgery, and 9 (3.9%) after the 6-month window. The cumulative incidence of VTE was 6.1% (95% CI, 4.3-8.8%) within 6 months after diagnosis and 8.5% (6.2-11.4%) within 1 year after diagnosis. Estimated blood loss (adjusted HR 1.22 [95% CI, 1.09-1.36], p = 0.001) and history of VTE (7.06 [2.34-21.29], p = 0.001) were independently associated with VTE. CONCLUSION With implementation of an ERAS protocol, only 1 in 46 patients experienced a VTE within 30 days after surgery. However, overall VTE occurred in 1 in 16 patients during first-line therapy. Strategies to further reduce VTE risk, especially during neoadjuvant chemotherapy and surveillance, should be investigated.
Collapse
Affiliation(s)
- Sue Li
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Alexandra S Bercow
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Michele Falzone
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, United States; Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, MA, United States
| | - Rajeshwari Kalyanaraman
- Department of Obstetrics and Gynecology, Saint Francis Hospital, Hartford, CT, United States
| | - Michael J Worley
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, MA, United States; Dana-Farber Cancer Institute, Boston, MA, United States
| | - Colleen M Feltmate
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, MA, United States; Dana-Farber Cancer Institute, Boston, MA, United States
| | - Andrea Pelletier
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, United States
| | - Kevin M Elias
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, MA, United States; Dana-Farber Cancer Institute, Boston, MA, United States.
| |
Collapse
|
3
|
Abstract
For patients undergoing major surgery, perioperative management according to an early recovery after surgery (ERAS) protocol focusing on early oral food intake is the strategy of choice. So-called perioperative nutritional (artificial) support now seems to be very traditional and outdated. Nevertheless, even in an overweight and obese society the prevalence of combined malnutrition and/or sarcopenia should not be underestimated. This results in the necessity for identification of patients at metabolic risk and the indications for nutritional therapy. This article provides a review of the current concepts of perioperative nutritional supplementation and discusses the available evidence and guideline recommendations.
Collapse
Affiliation(s)
- Arved Weimann
- Klinik für Allgemein‑, Viszeral- und Onkologische Chirurgie, Klinikum St. Georg gGmbH, Delitzscher Str. 141, 04129, Leipzig, Deutschland.
| |
Collapse
|
4
|
Abstract
Enhanced recovery after surgery (ERAS) has evolved over the past two decades. Originally aimed to standardize care among adults undergoing colorectal surgery, the tenets that developed have since been broadly accepted by a large number of adult surgical subspecialties, including bariatric surgery. This multidisciplinary, patient-centered approach involving optimizing pre-, intra-, and postoperative phases of care has resulted in shorter hospitalizations, fewer complications, and lower mortality rates. Recently, multiple pediatric surgery subspecialties have adopted ERAS principles and have documented similar favorable outcomes. Among adolescent bariatric patients, outcomes following the implementation of ERAS have not yet been described. We will review the history and goals of ERAS and detail pediatric surgery specific implementations. We will also review outcomes associated with ERAS within specific pediatric surgical subspecialties. Lastly, we will discuss the current ERAS protocol developed at Children's Hospital Colorado for adolescent bariatric surgery.
Collapse
Affiliation(s)
- S Christopher Derderian
- Department of Pediatric Surgery Children's Hospital Colorado, University of Colorado School of Medicine, Aurora CO, United States.
| | - Kyle O Rove
- Department of Pediatric Surgery Children's Hospital Colorado, University of Colorado School of Medicine, Aurora CO, United States
| |
Collapse
|
5
|
Ziegelmueller BK, Jokisch JF, Buchner A, Grimm T, Kretschmer A, Schulz GB, Stief C, Karl A. Long-Term Follow-Up and Oncological Outcome of Patients Undergoing Radical Cystectomy for Bladder Cancer following an Enhanced Recovery after Surgery (ERAS) Protocol: Results of a Large Randomized, Prospective, Single-Center Study. Urol Int 2019; 104:55-61. [PMID: 31801154 DOI: 10.1159/000504236] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 10/16/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Enhanced recovery after surgery (ERAS) concepts are implemented in various surgical disciplines. For patients undergoing radical cystectomy, prospective data are still rare. In the year 2014, our group could prove significant benefits of ERAS for these patients in a prospective randomized study compared to a conservative regimen. OBJECTIVE To evaluate long-term follow-up results of ERAS concepts in patients undergoing radical cystectomy for bladder cancer. METHODS Of the 101 patients who had initially prospectively been randomized to ERAS or a conservative regimen, 35 patients could be included in the study. Median follow-up time was 83 months. Primary end point assessed quality of life. Secondary end points were cancer-specific survival and overall survival. RESULTS Five to seven years after the initial inclusion to the study, no significant difference regarding quality of life parameters was detected (p values range between 0.112 and 0.970). Continence status in patients with neobladder showed no significant differences between ERAS and conservative regimens (p = 0.785). Cancer-specific survival in the ERAS group did not differ significantly from that in the conservative group (49 vs. 58%, p = 0.725). CONCLUSIONS While ERAS represents an excellent way to improve postoperative reconvalescence and quality of life in the short-term follow-up, our data do not support the idea that there is also a long-term effect in terms of quality of life issues.
Collapse
Affiliation(s)
| | | | - Alexander Buchner
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Tobias Grimm
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | | | | | - Christian Stief
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Alexander Karl
- Department of Urology, Barmherzige Brüder Hospital, Munich, Germany
| |
Collapse
|
6
|
Saltzman AF, Warncke JC, Colvin AN, Carrasco A, Roach JP, Bruny JL, Cost NG. Development of a postoperative care pathway for children with renal tumors. J Pediatr Urol 2018; 14:326.e1-326.e6. [PMID: 29891188 DOI: 10.1016/j.jpurol.2018.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 05/03/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE To identify the factors associated with a shorter postoperative stay, as an initial step to develop a care pathway for children undergoing extirpative kidney surgery. STUDY DESIGN This study retrospectively reviewed patients managed with upfront open radical nephrectomy for renal tumors between 2005 and 2016 at a pediatric tertiary care facility. Univariate and multivariate logistic regression were performed to identify factors associated with early discharge (by postoperative day 4). RESULTS A total of 84 patients met inclusion criteria. Median age was 28.1 months (range 1.8-193.1). Thirty-four (40.5%) patients had a nasogastric tube postoperatively. The patients were advanced to a clear liquid diet on a median postoperative day 2 (range 0-7) and regular diet on a median postoperative day 3 (range 1-8). Median time from surgery to discharge was 5 days (range 2-12), with 38 (45.2%) discharged early. Univariate and multivariate logistic regression analyses showed that earlier resumption of regular diet (OR 0.523, P = 0.028) was positively associated with early discharge. Other analyzed factors were not significant (see Table). DISCUSSION Timely initiation of adjuvant therapy is a specific requirement of Children's Oncology Group (COG) protocols. Chemotherapy and radiation therapy are ideally initiated simultaneously, as early as possible, within 2 weeks of surgery. Thus, factors that can facilitate early discharge from the hospital can maximize protocol adherence with respect to timing of adjuvant therapy initiation and optimize patient outcome. This study shed light on several postoperative factors and how these relate to postoperative stay and recovery. Specifically, tumor size, pre-operative bowel preparation, extent of lymph node sampling, stage, operative time, estimated blood loss, surgical service, postoperative nasogastric tube use, transfusion, and chemotherapy prior to discharge were not associated with discharge timing. Early re-feeding was associated with early discharge. Thus, it seems reasonable that, when developing a postoperative care pathway for these patients, these factors be considered and specifically encourage early re-feeding. In pediatrics, data on early recovery after surgery protocols are limited, and high-quality studies are unavailable. Within pediatric urology, early recovery after surgery protocols in children undergoing major urologic reconstruction have been shown to reduce hospital stay and can decrease complication rates. It seems reasonable that a similar pathway can be applied to children undergoing radical nephrectomy for suspected malignancy. CONCLUSIONS For children with renal tumors who underwent radical nephrectomy, early re-feeding was associated with a shorter time to discharge. Use of bowel preparation and nasogastric tube did not appear to shorten time to discharge. These data are important for developing postoperative care pathways for these patients.
Collapse
Affiliation(s)
- A F Saltzman
- Department of Surgery, Division of Urology, University of Colorado School of Medicine and the Children's Hospital of Colorado, Aurora, CO, USA
| | - J C Warncke
- Department of Surgery, Division of Urology, University of Colorado School of Medicine and the Children's Hospital of Colorado, Aurora, CO, USA
| | - A N Colvin
- Department of Surgery, Division of Urology, University of Colorado School of Medicine and the Children's Hospital of Colorado, Aurora, CO, USA
| | - A Carrasco
- Department of Surgery, Division of Urology, University of Colorado School of Medicine and the Children's Hospital of Colorado, Aurora, CO, USA
| | - J P Roach
- Department of Surgery, Division of Pediatric Surgery, University of Colorado School of Medicine and the Children's Hospital of Colorado, Aurora, CO, USA
| | - J L Bruny
- Department of Surgery, Division of Pediatric Surgery, University of Colorado School of Medicine and the Children's Hospital of Colorado, Aurora, CO, USA
| | - N G Cost
- Department of Surgery, Division of Urology, University of Colorado School of Medicine and the Children's Hospital of Colorado, Aurora, CO, USA.
| |
Collapse
|
7
|
Abstract
There have been very few studies on applying fast-track principles to colostomy closures. We believe that outcome may be significantly improved with multimodal interventions in the peri-operative care of patients undergoing this procedure. A retrospective study was carried out comparing patients who had undergone colostomy closures by the fast-track and traditional care protocols at our centre. We intended to analyse peri-operative period and recovery in colostomy closures to confirm that fast-track surgery principles improved outcomes. Twenty-six patients in the fast-track arm and 24 patients in the traditional care arm had undergone colostomy closures. Both groups were comparable in terms of their baseline parameters. Patients in the fast-track group were ambulatory and accepted oral feeding earlier. There was a significant reduction in the duration of stay (4.73 ± 1.43 days vs. 7.21 ± 1.38 days, p = 0.0000). We did not observe a rise in complications or 30-day re-admissions. Fast-track surgery can safely be applied to colostomy closures. It shows earlier ambulation and reduction in length of hospital stay.
Collapse
Affiliation(s)
- Aditya J Nanavati
- Department of Surgery, Suchak Hospital, Malad (E) Mumbai, India ; 302, Mayfair Villa, 11th Road, Khar (W) Mumbai, 400052 India
| | | |
Collapse
|
8
|
Lee J, Kwon CHD, Kim JM, Shin M, Joh JW. Effect of early enteral nutrition after hepatectomy in hepatocellular carcinoma patients. Korean J Hepatobiliary Pancreat Surg 2012; 16:129-33. [PMID: 26388922 PMCID: PMC4574999 DOI: 10.14701/kjhbps.2012.16.4.129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Revised: 10/23/2012] [Accepted: 10/29/2012] [Indexed: 11/17/2022]
Abstract
Backgrounds/Aims To evaluate the effect of early enteral nutrition after hepatectomy in hepatocellular carcinoma (HCC) patients on postoperative gastrointestinal motility recovery and admission days, liver function and nutrition recovery, and postoperative complication. Methods From August 2010 to July 2011, 102 patients with primary HCC underwent hepatectomy. Forty two patients took a sip of water (SOW) at postoperative day (POD)#1, soft blended diet (SBD) at POD#2 (early diet group, ED group), otherwise 60 patients took a SOW at POD#3, SBD at POD#4 (conventional diet group, CD group). Postoperative flatus-pass day, stool-pass day, nausea, vomiting, admission days, immediate postoperative (POD#0) and POD#1, 3, 5, 7 profiles of albumin, prothrombin time (PT) INR, total bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), white blood cell (WBC), and POD#1, 3, 5, 7 profiles of C-reactive protein (CRP), and postoperative complications cases were compared between ED group and CD group. All clinical data were compared retrospectively. Results Flatus-pass days (p<0.01), stool-pass days (p<0.01) and postoperative admission days (p=0.012) were shorter in ED group. Total bilirubin levels were higher at POD#0, 1, 3 but lower or similar at POD#5, 7 in ED group. AST, ALT levels were higher at POD#0 but lower at POD#1, 3, 5. There were no significant differences in albumin, PT INR, WBC, CRP and postoperative complication rates. Conclusions ED group had no difference in nutritional recovery and postoperative complication rates compared to CD group but it has better gastrointestinal motility recovery, liver function recovery, and shorter postoperative admission days.
Collapse
Affiliation(s)
- Jonghwan Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Choon Hyuck David Kwon
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Milljae Shin
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|