Buprenorphine management: a conundrum for the anesthesiologist and beyond - a one-act play

2020 ◽  
Vol 45 (8) ◽  
pp. 656-659
Author(s):  
Shilen Thakrar ◽  
Josh Lee ◽  
Caitlin E Martin ◽  
John Butterworth IV
Keyword(s):  
Patient Outcomes ◽  
Perioperative Management ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Local Level ◽  
Evidence Based ◽  
National Guidelines ◽  
Evidence Based Guidelines ◽  
One Act ◽  
Patient Centric

We have witnessed a worldwide upsurge of streamlined enhanced recovery after surgery (ERAS) pathways advocating for consistency and compliance within their guidelines. At a recent national conference, two experts defended their institutional policies on perioperative management of buprenorphine, one defending its continuation, while the other suggesting its discontinuation. The moderator diplomatically proclaimed the need to have guidance at the institutional level and following it for favorable patient outcomes. Unfortunately, perioperative management of buprenorphine remains an understudied topic with a lack of national guidelines leading to variations at a local level despite its increased use nationally in the current opioid crisis. Although the moderator made a valid statement, we demonstrate via our one-act play the importance of recognizing a subset of the population within an ERAS pathway that necessitates multidisciplinary discussion, communication, and patient-centric care to formulate a perioperative plan coordinating a patient’s care. More robust research is needed to minimize variability in current practices and to further develop comprehensive evidence-based guidelines that encompass risk factors and anticipated postsurgical and peripartum pain for patients on buprenorphine.

scholarly journals EFEKTIVITAS PREEMTIF KETAMIN SUB DOSIS DALAM MENGURANGI KEBUTUHAN OPIOID INTRAOPERATIF DAN LAMA WAKTU EKSTUBASI

2021 ◽  
Vol 10 (2) ◽  
pp. 88-98
Author(s):  
Rizky Bagoes Septyawan
Keyword(s):  
Patient Outcomes ◽  
Low Dose ◽  
Perioperative Management ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
P Value ◽  
Preoperative Fasting ◽  
Postoperative Patient ◽  
Fentanyl Administration ◽  
Single Blind

Surgical perioperative management undergoes updates to support postoperative patient outcomes. The concept of longer preoperative fasting times, cleansing ofthe gastrointestinal tract, and re-feeding after 3-5 days after surgery has begun to be abandoned which is then formulated into a new protocol called ERAS(Enhanced Recovery After Surgery) including preoperative counseling, optimization of nutrients, the use of standard anesthesia and analgesy drugs, as well asearly mobilization using the concept of preemptive analgesia. The use of low-dose ketamine for postoperative analgesia has evolved in part due to nmdaantagonistic properties that reduce central sensitization and opioid tolerance but are still controversial. This study aims to study the effects of low-dose ketamineas a preemptive and evaluate the total needs of opiods, as well as the length of time extubation with single blind experimental research. Patients with label A gotpreemptive therapy of subdose ketamine while label B got perioperative standard analgesia therapy. Analgesia in groups A and B is administered before surgery.Treatment control is done with single blind control that is the patient does not know the type of drug given. The comparison of the amount of fentanyl in the controlgroup and treatment in this study was significantly different (p=0.044). The old comparison of extubation in both groups obtained a significant p value (<0.0001).Preemptive administration of subdose ketamine effectively decreases the amount of fentanyl administration used during surgery and shortens the extucation time. Keywords: Preemptive; Ketamin subdose; Fentanil; Extucation Time.

Observations from Implementation of the ERAS Protocol after DIEP Flap Breast Reconstruction

2021 ◽  
Author(s):  
Nicholas T. Haddock ◽  
Ricardo Garza ◽  
Carolyn E. Boyle ◽  
Sumeet S. Teotia
Keyword(s):  
Breast Reconstruction ◽  
Patient Outcomes ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Compliance Rate ◽  
Fluid Management ◽  
Control Group ◽  
Diep Flap ◽  
Deep Inferior Epigastric Perforator ◽  
Eras Protocol

Abstract Background The Enhanced Recovery After Surgery (ERAS) protocol is a multivariate intervention requiring the help of several departments, including anesthesia, nursing, and surgery. This study seeks to observe ERAS compliance rates and obstacles for its implementation at a single academic institution. Methods This is a retrospective study looking at patients who underwent deep inferior epigastric perforator (DIEP) flap breast reconstruction from January 2016 to September 2019. The ERAS protocol was implemented on select patients early 2017, with patients from 2016 acting as a control. Thirteen points from the protocol were identified and gathered from the patient's electronic medical record (EMR) to evaluate compliance. Results Two hundred and six patients were eligible for the study, with 67 on the control group. An average of 6.97 components were met in the pre-ERAS group. This number rose to 8.33 by the end of 2017. Compliance peaked with 10.53 components met at the beginning of 2019. The interventions most responsible for this increase were administration of preoperative medications, goal-oriented intraoperative fluid management, and administration of scheduled gabapentin postoperatively. The least met criterion was intraoperative ketamine goal of >0.2 mg/kg/h, with a maximum compliance rate of 8.69% of the time. Conclusion The introduction of new protocols can take over a year for full implementation. This is especially true for protocols as complex as an ERAS pathway. Even after years of consistent use, compliance gaps remain. Staff-, patient-, or resource-related issues are responsible for these discrepancies. It is important to identify these issues to address them and optimize patient outcomes.

The efficacy of Enhanced recovery after surgery (ERAS) for elderly patients with intertrochanteric fractures received surgery: study protocol for a randomized, blinded, controlled trial

2020 ◽  
Author(s):  
Mengchen Yin ◽  
Yinjie Yan ◽  
Zhaoxiang Fan ◽  
Niankang Fang ◽  
Hongbo Wan ◽  
...  
Keyword(s):  
Western Medicine ◽  
Intertrochanteric Fracture ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Care Pathway ◽  
Controlled Trial ◽  
Intramedullary Fixation ◽  
Perioperative Outcomes ◽  
Evidence Based ◽  
Randomized Controlled

Abstract Background: Intertrochanteric fracture (ITF) is increasing with the rapid increase in the aging population, often causes a high mortality rate in old patients and increases the economic burden of the family and society. ERAS (Enhanced Recovery after Surgery) is a powerful guarantee for patients to accelerate their recovery after surgery. TCM (traditional Chinese medicine) promote repair of injured tissues and eliminate traumatic aseptic inflammation. Therefore, this prospective randomized controlled clinical trial aims to evaluate the clinical effect of the evidence-based ERAS pathway of integrating TCM with and western medicine on perioperative outcomes in ITF patients undergoing intramedullary fixation, and provide reliable evidence-based data for applying the program to clinical practice. Methods/design: We will conduct a prospective randomized, blinded, controlled trial to compare the effectiveness of ERAS care pathway with traditional care pathway, and to investigate whether the ERAS care pathway can improve the perioperative outcome in ITF patients undergoing intramedullary fixation. A total of 60 patients with ITF will be enrolled and treated with the two care pathway, respectively. Length of stay, economic indicators, Harris score, VAS score, time get out of bed, 30-day readmission rates, postoperative transfusion rates, discharge to home and mortality will be evaluated. Any signs of acute adverse reactions will be recorded at each visit during treatment. Discussion: Although an evidence-based process using the best available literature and Delphi expert-opinion method has been used to establish an ERAS pathway of integrating TCM with western medicine. But, there is a lack of consensus about its effectiveness. This trial will provide convincing evidence about the effect of ERAS pathway Trial registration: Registered on 12 Oct 2019; Trial number is ChiCTR190t0026487 Keywords: intertrochanteric fracture; enhanced recovery after surgery; perioperative period; integrating TCM with and western medicine; randomized controlled trial

scholarly journals Comparative Effectiveness of Enhanced Recovery After Surgery Program Combined With Single-Incision Laparoscopic Surgery in Colorectal Cancer Surgery: A Retrospective Analysis

2022 ◽  
Vol 11 ◽  
Author(s):  
Changgang Wang ◽  
Haoran Feng ◽  
Xiaoning Zhu ◽  
Zijia Song ◽  
You Li ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Laparoscopic Surgery ◽  
Retrospective Study ◽  
Perioperative Management ◽  
Single Incision ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Single Incision Laparoscopic Surgery ◽  
Group A ◽  
Group B

BackgroundRecently, enhanced recovery after surgery (ERAS) has been widely used in the perioperative management of colorectal cancer (CRC). This study aimed to evaluate the safety and feasibility of ERAS combined with single-incision laparoscopic surgery (SILS) in CRC surgery.MethodsThis was a retrospective study of patients with CRC who underwent surgery between April 2018 and April 2020 in Ruijin Hospital(North), Shanghai Jiaotong University School of Medicine. The patients were divided into three groups: group A (n=138), patients who underwent traditional multiport laparoscopic colectomy with conventional perioperative management; group B (n=63), patients who underwent SILS; and group C (n=51), patients who underwent SILS with ERAS.ResultsOverall, 252 participants were included in the retrospective study. The median operation time (min) in group B and group C was shorter than that in group A (group A 134.0 ± 42.5; group B 117 ± 38.9; group C 111.7 ± 35.4, p=0.004). The estimated surgical blood loss (ml) was lower in groups B and C than in group A (group A 165.1 ± 142.2; group B 122.0 ± 79.4; group C 105.2 ± 55.8, p=0.011). The length of surgical incision (cm) was shorter in groups B and C than in group A (group A 7.34 ± 1.05; group B 5.60 ± 0.80; group C 5.28 ± 0.52, p&lt;0.001). The time before first flatus (hours) in group C was shorter than in groups A and B (group A 61.85 ± 21.14; group B 58.30 ± 20.08; group C 42.06 ± 23.72; p&lt;0.001). The days prior to the administration of free oral fluids in group C was shorter than in groups A and B (group A 4.79 ± 1.28; group B 4.67 ± 1.11; group C 2.62 ± 0.64; p&lt;0.001). The days of prior solid diet was less in group C than in groups A and B (group A 7.22 ± 3.87; group B 7.08 ± 3.18; group C 5.75 ± 1.70; p=0.027). The postoperative length of stay (LOS) was less in group C compared with that in groups A and B (group A 9.46 ± 4.84 days; group B 9.52 ± 7.45 days; group C 7.20 ± 2.37 days; p=0.023). The visual analog scale (VAS) scores on day 0, 1, and 2 in groups B and C were lower than those in group A (day 0, p&lt;0.001; day 1, p&lt;0.001; day 2, p=0.002), while the VAS score on day 3 showed no differences in the three groups (group A 1.29 ± 1.38; group B 0.98 ± 1.24; group C 0.75 ± 0.64, p=0.018).ConclusionThe findings suggest that SILS combined with ERAS may be a feasible and safe procedure for CRC surgery because it provides favorable cosmetic results, early dietary resumption, shorter hospital stays, and appropriate control of postoperative pain without increases in complications or readmission rates compared to conventional perioperative care with SILS or conventional laparoscopic surgery(CLS) of CRC. Further prospective randomized controlled studies are needed to enhance evidence-based medical evidence.

scholarly journals Enhanced recovery after surgery (ERAS) in clinical practice

2020 ◽  
Vol 24 (3) ◽  
Author(s):  
Robert Leger ◽  
Jon Livelsberger ◽  
Ashish Sinha
Keyword(s):  
Clinical Practice ◽  
Length Of Stay ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Evidence Based ◽  
Wide Spread ◽  
Postsurgical Complications ◽  
Protocol Compliance ◽  
Care Practices ◽  
Multidisciplinary System

‘Enhanced Recovery After Surgery’ (ERAS) protocols are an evidence-based, multidisciplinary system for patient care that— since its emergence in 2001— has shown remarkable efficacy in reducing surgical complications, shortening length of stay (LoS), and the incidence of hospital re-admission. Unfortunately, wide spread acceptance of ERAS has been slow, as it conflicts with some traditional perioperative care practices. However, with protocol compliance >70%, studies have shown significant reduction in mortality and postsurgical complications, with 30-50% reduction in LoS and approximately a 50% reduction in complications.

scholarly journals To What Extend does Reported Practice from Nurses in Management of Indwelling Urinary Catheters Reflect National Evidence-based Guidelines?

2019 ◽  
Vol 4 (1) ◽  
Keyword(s):  
Urinary Catheter ◽  
Poor Performance ◽  
Evidence Based ◽  
National Guidelines ◽  
Training And Education ◽  
Hospital Acquired Infections ◽  
Bladder Scan ◽  
Induction Process ◽  
Evidence Based Guidelines ◽  
Hospital Acquired

In recent years, Catheter-Associated Urinary Tract Infection (CAUTI) has progressively developed into a major hospital complication accounting for 60% of hospital-acquired infections; it is costly and morbid. Nurses account for more than half of the catheterisation conducted within hospitals. Due to this reason, it was important to identify whether nursing practice on the management of indwelling urinary catheter was in the reflection of the current national guidelines. The survey is conducted on 32 participants who reveal the strengths and limitation within the areas. Nurses account for more than half of the catheterisation conducted within the hospital. In order to prevent CAUTI complication, the research suggested training and education as the main solution since nurses significantly exhibited poor performance in terms of knowledge and skills in the area of catheterisation, especially in the induction process. Moreover, the study reveals that the use of bladder scan and system intervention which has been identified to reduce the number of catheter insertions contributes to the reduction of urinary bacterial infection.

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