Attitudes of patients and care providers to enhanced recovery after surgery programs after major abdominal surgery

Abstract Background: Restrictive fluid therapy is essential to enhanced recovery after surgery. A meta-analysis was conducted to explore the safety of restrictive fluid therapy for major abdominal surgery and compare it with liberal fluid therapy. Methodology : We searched MEDLINE, the Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs), the WHO International Clinical Trials Registry Platform, and EMBASE in which restrictive and liberal fluid therapies were compared. Data on complications, anastomotic leaks, and wound infections were extracted. Results: Eleven RCTs comparing the two therapies were included. Compared with liberal fluid therapy, restrictive fluid therapy lowered the risk of complications and cardiopulmonary dysfunction and had similar rates of mortality, anastomotic leak, pneumonia and would infection. But increased kidney injury was also observed in restrictive fluid therapy. Conclusion: Restrictive fluid therapy is safe but may have potential dangers, so caution is warranted in its application.

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Enhanced Recovery After Surgery: Applicability and Results for Abdominal Surgery and Impediments for Universal Usage

GI Surgery Annual ◽

10.1007/978-981-13-0161-2_7 ◽

2018 ◽

pp. 153-176

Author(s):

Vikram Kate ◽

Mohsina Subair ◽

R. Kalayarasan ◽

N. Ananthakrishnan

Keyword(s):

Abdominal Surgery ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery

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Enhanced Recovery and the Changing Landscape of Major Abdominal Surgery

Anesthesiology Clinics ◽

10.1016/j.anclin.2014.12.001 ◽

2015 ◽

Vol 33 (1) ◽

pp. xv-xvi

Author(s):

Timothy E. Miller ◽

Michael J. Scott

Keyword(s):

Abdominal Surgery ◽

Enhanced Recovery ◽

Major Abdominal Surgery

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The Effect of Scheduled Intravenous Acetaminophen in an Enhanced Recovery Protocol Pathway in Patients Undergoing Major Abdominal Procedures: A Prospective, Randomized, and Placebo-Controlled Clinical Trial

Pain Medicine ◽

10.1093/pm/pnab272 ◽

2021 ◽

Author(s):

Kathirvel Subramaniam ◽

Stephen A Esper ◽

Kushanth Mallikarjun ◽

Alec Dickson ◽

Kristin Ruppert ◽

...

Keyword(s):

Clinical Trial ◽

Pain Relief ◽

Abdominal Surgery ◽

Rating Scale ◽

Enhanced Recovery ◽

Academic Medical Center ◽

Tertiary Care ◽

Major Abdominal Surgery ◽

Number Of Patients ◽

Group A

Abstract Objective Enhanced recovery protocols (ERPs) utilize multi-modal analgesia regimens. Individual regimen components should be evaluated for their analgesic efficacy. We evaluated the effect of scheduled intravenous (IV) acetaminophen within an ERP on analgesia and recovery after a major abdominal surgery. Design This study is a prospective, randomized, double-blinded clinical trial. Setting The study setting was a tertiary care, academic medical center. Subjects Adult patients scheduled for elective major abdominal surgical procedures Methods Patients in group A received 1g IV acetaminophen, while patients in group P received IV placebo every six hours for 48 hours postoperatively within an ERP. Pain scores, opioid requirements, nausea and vomiting, time to oral intake and mobilization, length of stay, and patient satisfaction scores were measured and compared. Results From 412 patients screened, 154 patients completed the study (Group A: 76, Group P: 78). Primary outcome was the number of patients with unsatisfactory pain relief, defined as a composite of average Numeric Rating Scale (NRS) scores above 5 and requirement of IV patient-controlled analgesia for pain relief during the first 48 hours postoperatively, and was not significantly different between the two groups (33 (43.4%) in group A versus 42 (53.8%) patients in group P, p=0.20). Opioid consumption was comparable between two groups. Group A utilized significantly less postoperative rescue antiemetics compared to group P (41% vs. 58%, p= 0.02). Conclusions Scheduled administration of IV acetaminophen did not improve postoperative analgesia or characteristics of postoperative recovery in patients undergoing major abdominal surgery within an ERP pathway.

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