Analgesia After Open Abdominal Surgery in the Setting of Enhanced Recovery Surgery

Abstract Background It is uncertain whether the association of the intraoperative driving pressure (ΔP) with postoperative pulmonary complications (PPCs) depends on the surgical approach during abdominal surgery. Our primary objective was to determine and compare the association of time–weighted average ΔP (ΔPTW) with PPCs. We also tested the association of ΔPTW with intraoperative adverse events. Methods Posthoc retrospective propensity score–weighted cohort analysis of patients undergoing open or closed abdominal surgery in the ‘Local ASsessment of Ventilatory management during General Anaesthesia for Surgery’ (LAS VEGAS) study, that included patients in 146 hospitals across 29 countries. The primary endpoint was a composite of PPCs. The secondary endpoint was a composite of intraoperative adverse events. Results The analysis included 1128 and 906 patients undergoing open or closed abdominal surgery, respectively. The PPC rate was 5%. ΔP was lower in open abdominal surgery patients, but ΔPTW was not different between groups. The association of ΔPTW with PPCs was significant in both groups and had a higher risk ratio in closed compared to open abdominal surgery patients (1.11 [95%CI 1.10 to 1.20], P < 0.001 versus 1.05 [95%CI 1.05 to 1.05], P < 0.001; risk difference 0.05 [95%CI 0.04 to 0.06], P < 0.001). The association of ΔPTW with intraoperative adverse events was also significant in both groups but had higher odds ratio in closed compared to open abdominal surgery patients (1.13 [95%CI 1.12– to 1.14], P < 0.001 versus 1.07 [95%CI 1.05 to 1.10], P < 0.001; risk difference 0.05 [95%CI 0.030.07], P < 0.001). Conclusions ΔP is associated with PPC and intraoperative adverse events in abdominal surgery, both in open and closed abdominal surgery. Trial registration LAS VEGAS was registered at clinicaltrials.gov (trial identifier NCT01601223).

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Letter to the Editor: Standard of Care and Outcomes of Primary Laparotomy Versus Laparotomy in Patients with Prior Open Abdominal Surgery (ReLap Study; DRKS00013001)

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-021-04977-4 ◽

2021 ◽

Author(s):

Abhishek Arora ◽

Ashesh Kumar Jha ◽

Manoj Kumar

Keyword(s):

Abdominal Surgery ◽

Standard Of Care ◽

Letter To The Editor ◽

Open Abdominal Surgery

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Association between Blood Potassium Level and Recovery of Postoperative Gastrointestinal Motility during Continuous Renal Replacement Therapy in Patient Undergoing Open Abdominal Surgery

BioMed Research International ◽

10.1155/2019/6392751 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8

Author(s):

Yi Yang ◽

Jingjuan Yang ◽

Xiner Yao ◽

Yu Cui ◽

Xiabing Lang ◽

...

Keyword(s):

Abdominal Surgery ◽

Gastrointestinal Motility ◽

Potassium Level ◽

Potassium Concentration ◽

Binary Logistic Regression ◽

Plasma Potassium ◽

Postoperative Recovery ◽

Binary Logistic Regression Model ◽

Open Abdominal Surgery ◽

Blood Potassium

Background. The aim of this study was to identify the blood potassium level beneficial to the postoperative recovery of gastrointestinal motility during continuous renal replacement therapy (CRRT) in patient undergoing open abdominal surgery. Materials and Methods. 538 critically ill patients after open abdominal surgery and receiving CRRT were retrospectively recruited as the study cohort. Demographic and clinical data were recorded along with an evaluation of the postoperative gastrointestinal motility. Results. Correlation analysis was used to assess the correlation coefficient, and then the variables with correlation coefficient value less than 0.5 were included in the binary logistic regression model. Binary logistic regression model indicated that the postoperative blood potassium level was independently associated with the recovery of gastrointestinal motility (OR=0.109, 95% CI= 0.063 to 0.190, p<0.001). Based on the normal range of blood potassium level, we selected the cut-off point of blood potassium level via Weight of Evidence analysis, which was 4.00 mmol/L. Compared with the patients with insufficient blood potassium levels (plasma potassium concentration < 4.00 mmol/L), those with sufficient blood potassium levels (plasma potassium concentration≥ 4.00 mmol/L) conferred an increase in the rate of 4-day postoperative recovery of gastrointestinal motility (OR= 4.425, 95% CI = 2.933 to 6.667, p<0.001). Conclusions. Maintaining the blood potassium concentrations at a relatively high level of the normal blood potassium range during CRRT would be beneficial to postoperative recovery of gastrointestinal motility.

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Randomized Comparison of Subcuticular Sutures Versus Staples for Skin Closure After Open Abdominal Surgery: a Multicenter Open-Label Randomized Controlled Trial

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-016-3283-z ◽

2016 ◽

Vol 20 (12) ◽

pp. 2083-2092 ◽

Cited By ~ 9

Author(s):

Kazuhiro Imamura ◽

Kensuke Adachi ◽

Ritsuko Sasaki ◽

Satoko Monma ◽

Sadaaki Shioiri ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Abdominal Surgery ◽

Controlled Trial ◽

Skin Closure ◽

Open Label ◽

Randomized Controlled ◽

Open Abdominal Surgery

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Rationale and study design of PROVHILO - a worldwide multicenter randomized controlled trial on protective ventilation during general anesthesia for open abdominal surgery

Trials ◽

10.1186/1745-6215-12-111 ◽

2011 ◽

Vol 12 (1) ◽

Cited By ~ 32

Author(s):

Sabrine NT Hemmes ◽

Paolo Severgnini ◽

Samir Jaber ◽

Jaume Canet ◽

Hermann Wrigge ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Abdominal Surgery ◽

General Anesthesia ◽

Study Design ◽

Controlled Trial ◽

Protective Ventilation ◽

Randomized Controlled ◽

Multicenter Randomized Controlled Trial ◽

Open Abdominal Surgery

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Dezocine Prevents Postoperative Hyperalgesia in Patients Undergoing Open Abdominal Surgery

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2015/946194 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Fang Yu ◽

Jie Zhou ◽

Suyun Xia ◽

Huan Xu ◽

Xiangrui Wang

Keyword(s):

Treatment Group ◽

Abdominal Surgery ◽

Pain Threshold ◽

Controlled Trial ◽

Thermal Hyperalgesia ◽

Postoperative Nausea And Vomiting ◽

Open Gastrectomy ◽

Sham Treatment ◽

Pain Scores ◽

Open Abdominal Surgery

Objective. Postoperative hyperalgesia is very frequent and hard to treat. Dezocine is widely used and has a modulatory effect for thermal hyperalgesia in animal models. So, this study was designed to investigate the potential role of dezocine in decreasing postoperative hyperalgesia for patients undergoing open abdominal surgery.Methods. This is a randomized, double-blinded, and placebo-controlled trial. 50 patients for elective open gastrectomy were randomly allocated to either a true treatment group (0.15 mg/kg intravenous dezocine at the end of surgery) or a sham treatment group (equivalent volume of saline) in a 1 : 1 ratio. Patients were followed up for 48 hours postoperatively and pain threshold to Von Frey filaments, pain scores, PCIA consumption, rescue analgesics use, sedation score, and occurrence of postoperative nausea and vomiting were recorded.Results. Patients in the true treatment group experienced statistically significantly higher pain threshold on forearm and smaller extent of peri-incisional hyperalgesia than the sham treatment group. Rescue analgesic use, cumulative PCIA consumption, and pain scores were statistically significantly decreased in the true treatment group compared to the sham treatment group.Conclusions. Dezocine offers a significant antihyperalgesic and analgesic effect in patients undergoing elective open gastrectomy for up to 48 hours postoperatively.

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