Effectiveness of Postoperative Pain Management By Multimodal Analgesia Without Epidural Analgesia After Laparoscopic Colon Cancer Surgery: A Prospective Cohort Study

Abstract Background:Although epidural analgesia has been recommended for its strong analgesic effect for postoperative analgesia management, the increasing number of patients undergoing anticoagulant or antiplatelet therapy to treat cerebrocardiovascular diseases cannot receive epidural analgesia given the risk of serious complications, including epidural hematoma. We aimed to evaluate the analgesic effects of multimodal analgesia involving intravenous patient-controlled analgesia (IV-PCA), and repeated scheduled acetaminophen administration, and block as local anesthesia, to establish postoperative analgesia management method replacing epidural analgesia in laparoscopic colectomy.Methods:We enrolled patients undergoing laparoscopic surgery for colorectal cancer at our hospital. The primary outcome was days of postoperative hospital stay. The efficacies of multimodal and epidural analgesia were compared. The secondary outcomes were the pain assessment and safety.Results:We registered 48 patients; among them, 40 patients were eligible. The mean postoperative hospital stay was 9.00 days (95% CI = 8.19 to 9.39, p < 0.0001). There were relatively high pain scores from postoperative day (POD) 0-1, which subsequently decreased and reach their lowest value at POD 4-5.Conclusions:Multimodal analgesia with IV-PCA and repeated scheduled acetaminophen administration could provide a safe and effective analgesic effect after laparoscopic colectomy and may be a postoperative analgesia management alternative to epidural analgesia.

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Epidural analgesia after minimally invasive esophagectomy: efficacy and complication profile

Diseases of the Esophagus ◽

10.1093/dote/doy116 ◽

2018 ◽

Vol 32 (8) ◽

Cited By ~ 5

Author(s):

B F Kingma ◽

E Visser ◽

M Marsman ◽

J P Ruurda ◽

R van Hillegersberg

Keyword(s):

Minimally Invasive ◽

Epidural Analgesia ◽

Rating Scale ◽

Minimally Invasive Esophagectomy ◽

Sensory Block ◽

Postoperative Pain Management ◽

Pain Medication ◽

Uneventful Recovery ◽

Invasive Esophagectomy ◽

Number Of Patients

SUMMARY Adequate postoperative pain management is essential to facilitate uneventful recovery after esophagectomy. Although epidural analgesia is the gold standard, it is not satisfactory in all patients. The aim of this study is to describe the efficacy and complication profile of epidural analgesia after minimally invasive esophagectomy (MIE). A total of 108 patients who underwent a robot-assisted (McKeown) MIE for esophageal cancer were included from a single center prospective database (2012–2015). The number of patients that could receive epidural analgesia, the sensory block range per day, the number of epidural top-ups, the need for escape pain mediation (i.e. intravenous opioids), the highest pain score per day (numeric rating scale: 0–10), and epidural-related complications were assessed until postoperative day (POD) 4. Epidural catheter placement was achieved in 101 patients (94%). A complete sensory block was found in 49% (POD1), 42% (POD 2), 20% (POD3), and 30% (POD4) of patients. An epidural top-up was performed in 26 patients (24%), which was successful in 22 patients. Escape pain medication in the form of intravenous opioids was given at least once in 49 out of 108 patients (45%) on POD 1, 2, 3, or 4. Overall median highest pain scores on the corresponding days were 2.0 (range: 0–10), 3.5 (range: 0–9), 3.0 (range: 0–8), and 4.0 (range: 0–9). Epidural related complications occurred in 20 patients (19%) and included catheter problems (n = 11), hypotension (n = 6), bradypnea (n = 2), and reversible tingling in the legs (n = 1). In conclusion, in this study epidural analgesia was insufficient and escape pain medication was necessary in nearly half of patients undergoing MIE.

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Surgical strategy of empyema thoracis in children: open thoracotomy v/s video assisted thoracoscopy

International Surgery Journal ◽

10.18203/2349-2902.isj20184741 ◽

2018 ◽

Vol 5 (12) ◽

pp. 3823

Author(s):

Pranav Jadhav ◽

Sanjay Raut ◽

Manish Kumar Kashyap ◽

Riddhi Ajay Bora

Keyword(s):

Hospital Stay ◽

Operative Time ◽

Statistical Significance ◽

Postoperative Hospital Stay ◽

Empyema Thoracis ◽

Open Thoracotomy ◽

Appropriate Treatment ◽

Estimated Blood Loss ◽

Number Of Patients ◽

Prolonged Air Leak

Background: Empyema is the suppuration within the pleural cavity, most commonly a complication of acute bacterial pneumonia. It is one of the most common diseases in children in India. Prognosis is excellent, provided appropriate treatment is administered early in the course of the disease.Methods: This study examines treatment of complex empyema thoracis between June 1, 2016, and April 30, 2018. Total number of patients were 30 cases in open thoracotomy and 30 in VATS in treatment of their disease. Effusion etiology was distributed as follows: infectious, neoplastic-associated, traumatic.Results: A total of 30 patients underwent VATS debridement and open thoracotomy for treatment of empyema thoracis. The median postoperative hospital stay was 10.31±3.751 days in case of VATS and 4.41±1.593 days in case of open thoracotomy. Median estimated blood loss in case of VATS was 78±15.634 ml and in case of open thoracotomy was 15.97±5.871 ml. Mean operative time was 82.86±17.293 minutes in case VATS and 77.59±13.38 minutes in case of open thoracotomy.Conclusions: VATS might be comparable or even better than open thoracotomy in terms of operative time, postoperative hospital stay, chest tube duration, prolonged air leak rate, morbidity and mortality. But referring to the relapse rate, there was no statistical significance.

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Comparative evaluation of options for postoperative analgesia during surgical correction of congenital spine deformity in children

Pediatric Traumatology Orthopaedics and Reconstructive Surgery ◽

10.17816/ptors7363-70 ◽

2019 ◽

Vol 7 (3) ◽

pp. 63-70

Author(s):

Alexander S. Kozyrev ◽

Anna V. Zaletina ◽

Kirill A. Kartavenko ◽

Angelina S. Strelnikova ◽

Maria S. Pavlova

Keyword(s):

Pain Relief ◽

Epidural Analgesia ◽

Postoperative Analgesia ◽

Postoperative Period ◽

Clinical Laboratory ◽

Surgical Correction ◽

Spine Deformity ◽

Surgical Interventions ◽

Number Of Patients ◽

Main Component

Background. In the planning of anesthesia and postoperative therapy for surgical correction of congenital spinal deformity, the volume, the spine that is operated, and the patients age are all factors to consider. In pediatric practice, the use of opioid analgesics for pain relief in the postoperative period after extensive and traumatic surgical interventions is generally accepted. There is very little information on the effectiveness and safety of prolonged epidural analgesia in young children in spinal surgery. Aim. The aim of this study was to give a comparative assessment of the use of prolonged epidural blockade and constant drip of fentanyl as the main components of postoperative analgesia during surgical correction of congenital spine deformity caused by violation of the vertebra formation in children. Materials and methods. The features of the postoperative period in 43 cases of correction of congenital spine curvature performed in the Turner Scientific Research Institute for Childrens Orthopedics from 2016 to 2018 were retrospectively evaluated. Patient age ranged from 2 to 11 years. The patients were divided into two groups: group P included 22 patients whose main component of postoperative anesthesia was prolonged epidural analgesia, and group F included 21 patients whose main component of postoperative anesthesia was fentanyl. Anamnestic data analysis and clinical, laboratory, instrumental, and statistical analyses were used as methods of assessment. Results. The data showed that the number of patients with undesirable respiratory disorders recorded in the first day in the form of bradypnea and desaturation was higher in group F than in group P. The number of patients who experienced nausea and vomiting and those who received antiemetics on the first day after surgery were comparable in both groups. However, the number of patients with fixed nausea, vomiting, and receiving antiemetics became significantly higher in group F in the next 2 days. In addition, at all stages of the assessment, there was an increase in the recorded episodes of peristalsis inhibition in patients from group F. The number of patients, who required additional anesthesia within 3 days of observation was comparable in both groups. Conclusion. Prolonged epidural analgesia and constant drip of fentanyl are equally effective for providing pain relief in the postoperative period, but prolonged epidural analgesia provides a significant reduction in the frequency and severity of the gastrointestinal tract dysfunction.

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Effects of perioperative S (+) ketamine infusion added to multimodal analgesia in patients undergoing ambulatory haemorrhoidectomy

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2010.01.001 ◽

2010 ◽

Vol 1 (2) ◽

pp. 100-105 ◽

Cited By ~ 5

Author(s):

Ulrich J. Spreng ◽

Vegard Dahl ◽

Johan Ræder

Keyword(s):

Side Effects ◽

Postoperative Analgesia ◽

Analgesic Effect ◽

Low Dose ◽

Isotonic Saline ◽

Multimodal Analgesia ◽

Controlled Study ◽

Double Blind ◽

Pain Scores ◽

Pacu Stay

AbstractBackground and objectivePerioperative low-dose ketamine has been useful for postoperative analgesia. In this study we wanted to assess the analgesic effect and possible side-effects of perioperative low-dose S (+) ketamine when added to a regime of non-opioid multimodal pain prophylaxis.MethodsSeventy-seven patients scheduled for haemorrhoidectomy were enrolled in this randomized, double-blind, controlled study. They received oral paracetamol 1–2 g, total intravenous anaesthesia, intravenous 8 mg dexamethasone, 30 mg ketorolac and local infiltration with bupivacaine/epinephrine. Patients randomized to S (+) ketamine received an intravenous bolus dose of 0.35 mg kg−1 S (+) ketamine before start of surgery followed by continuous infusion of 5 μg kg−1 min−1 until 2 min after end of surgery. Patients in the placebo group got isotonic saline (bolus and infusion). BISTM monitoring was used. Pain intensity and side-effects were assessed by blinded nursing staff during PACU stay and by phone 1, 7 and 90 days after surgery.ResultsIn patients randomized to S (+) ketamine emergence from anaesthesia was significantly longer (13.1 min vs. 9.3 min; p < 0.001). BIS values were significantly higher during anaesthesia (maximal value during surgery: 62 vs. 57; p = 0.01) and when opening eyes (81 vs. 70, p < 0.001). Pain scores (NRS and VAS) did not differ significantly between groups.ConclusionsThe addition of perioperative S (+) ketamine for postoperative analgesia after haemorrhoidectomy on top of multimodal non-opioid pain prophylaxis does not seem to be warranted, due to delayed emergence and recovery, more side-effects, altered BIS readings and absence of additive analgesic effect.

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Is Prophylactic Abdominal Drainage Necessary After Laparoscopic Colectomy For Colon Cancer? A Propensity Score-Matched Analysis

10.21203/rs.3.rs-1187663/v1 ◽

2021 ◽

Author(s):

Le Huy Luu ◽

Tran Van Hoi ◽

Nguyen Van Hai ◽

Nguyen Anh Dung ◽

Do Dinh Cong ◽

...

Keyword(s):

Colon Cancer ◽

Propensity Score ◽

Hospital Stay ◽

Laparoscopic Colectomy ◽

Right Hemicolectomy ◽

Postoperative Hospital Stay ◽

Routine Practice ◽

Middle Income ◽

Prophylactic Drainage ◽

Drain Group

Abstract Background: In 2018, the Enhanced Recovery After Surgery (ERAS) Society recommended against routine drainage after colorectal surgery. However, the evidence is relatively old and few studies were performed in low-to-middle income country (LMIC) setting. This study aimed to compare outcomes of laparoscopic colectomy with and without prophylactic drainage for colon cancer.Methods: A retrospective study was performed from 2018 to 2021 with patients who underwent laparoscopic colectomy with D3 lymphadenectomy for colon cancer. The use of prophylactic drainage was depended on routine practice of surgeons. Outcomes were postoperative complications and postoperative hospital length of stay. The drain and no-drain groups were compared using propensity score-matched (PSM) analysis.Results: The study included 143 patients (59 in the drain group and 84 in the no-drain group). The PSM resulted in 94 patients (47 in each group). Median age was 62 years. The most frequent was right hemicolectomy (33.6%), followed by left hemicolectomy (32.2%), sigmoid colectomy (21%), extended right hemicolectomy (9.8%), transverse hemicolectomy (2.1%), and total colectomy (1.4%). Postoperative hospital stay was significantly shorter in the no-drain group (median of 5 versus 6 days). The no-drain group also had lower rate of complications (23.8% versus 30.5% and 23.4% versus 34% before and after matching respectively) and less severe complications based on Clavien-Dindo classification, but the difference was not significant.Conclusions: Laparoscopic colectomy without prophylactic drainage is safe in the treatment of colon cancer. This approach can shorten postoperative hospital stay and should be applied even in the LMIC setting.Main novel aspect: Laparoscopic colectomy without prophylactic drainage for colon cancer can be applied in low-to-middle income settings.

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Patterns of Improvement in Resection of Hepatocellular Carcinoma in Cirrhotic Patients: Results of a Non Drainage Policy

HPB Surgery ◽

10.1155/1989/31824 ◽

1989 ◽

Vol 1 (2) ◽

pp. 141-147 ◽

Cited By ~ 6

Author(s):

C. Smadja ◽

L. Berthoux ◽

J. L. Meakins ◽

D. Franco

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Resection ◽

Postoperative Complications ◽

Hospital Stay ◽

Postoperative Hospital Stay ◽

Abdominal Drainage ◽

Number Of Patients ◽

Cirrhotic Patients ◽

Technical Details ◽

Clinically Significant

A prolonged ascitic leak through abdominal drains is a source of postoperative complications and of prolonged postoperative hospital stay after liver resection for hepatocellular carcinoma (HCC) in cirrhotic patients. Therefore we elected to abstain from routine abdominal drainage in the last 14 resections in cirrhotic livers. A significantly smaller number of patients had postoperative complications following liver resections without drainage (7%) than historical controls with abdominal drainage (59%, p < 0.01). The number of complications related to ascites was significantly greater in patients with abdominal drainage (76%) than without (0%, p < 0.001). Postoperative hospital stay was also significantly longer following resections with abdominal drainage (19 ± 4 days) than in patients without (12 ± 1 days, p < 0.01). The long postoperative hospital stay in patients with abdominal drainage was related to ascitic discharge for a mean period of 13 ± 10 days. No clinically significant accumulation of ascites was noted in patients without drainage. A more frequent utilization of hepatic vascular inflow occlusion did not account for the better results in the group of patients without drainage. These results suggest that routine abdominal drainage should not be used following liver resection for HCC in cirrhotic patients. This appears to be another of the technical details improving postoperative results in these patients.

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Postoperative Anesthesia Of Elderly And Senile Patients With Total Joint Replacement Of The Lower Extremities

The American Journal of Medical Sciences and Pharmaceutical Research ◽

10.37547/tajmspr/volume02issue09-16 ◽

2020 ◽

Vol 2 (09) ◽

pp. 75-81

Author(s):

Gaziev Z.T. ◽

Avakov V.E. ◽

Shorustamov M.T. ◽

Bektemirova N.T.

Keyword(s):

Epidural Analgesia ◽

Postoperative Period ◽

Joint Replacement ◽

Total Joint Replacement ◽

Lower Extremities ◽

Multimodal Analgesia ◽

Control Group ◽

Patient Controlled Analgesia ◽

Physical Status ◽

Traumatic Injuries

Objective: To evaluate the efficacy and safety of patient-controlled analgesia through prolonged epidural analgesia after joint replacement of the lower extremities. Material and methods. We analyzed the postoperative period of 213 elderly and senile patients who were operated on for degenerative-dystrophic and traumatic injuries of the joints of the lower extremities. All patients underwent total joint replacement (164 - THA and 49 - TKA). The age of patients is from 65 to 90 years (average age was 78 ± 8 years) with a physical status of ASA 3 and above. All examined patients were divided into 2 groups. 63 patients comprised the main group, which in the postoperative period underwent patient-controlled analgesia (PCA) through prolonged epidural analgesia. The control group consisted of 150 patients, for the anesthesia of which in the postoperative period only standard systemic multimodal analgesia was used Conclusion. Patient-controlled analgesia is an alternative to traditional analgesic regimens. This method should be one of the main methods after surgical anesthesia for joint replacement of the lower limb in elderly and senile patients.

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Pain management after lung surgery

Nursing Reports ◽

10.4081/nursrep.2014.3225 ◽

2014 ◽

Vol 4 (1) ◽

Cited By ~ 2

Author(s):

Maria Frödin ◽

Margareta Warrén Stomberg

Keyword(s):

Quality Of Care ◽

Pain Management ◽

Postoperative Pain ◽

Severe Pain ◽

Postoperative Pain Management ◽

Lung Surgery ◽

Moderate Pain ◽

Number Of Patients ◽

Severe Postoperative Pain

Pain management is an integral challenge in nursing and includes the responsibility of managing patients’ pain, evaluating pain therapy and ensuring the quality of care. The aims of this study were to explore patients’ experiences of pain after lung surgery and evaluate their satisfaction with the postoperative pain management. A descriptive design was used which studied 51 participants undergoing lung surgery. The incidence of moderate postoperative pain varied from 36- 58% among the participants and severe pain from 11-26%, during their hospital stay. Thirty-nine percent had more pain than expected. After three months, 20% experienced moderate pain and 4% experienced severe pain, while after six months, 16% experienced moderate pain. The desired quality of care goal was not fully achieved. We conclude that a large number of patients experienced moderate and severe postoperative pain and more than one third had more pain than expected. However, 88% were satisfied with the pain management. The findings confirm the severity of pain experienced after lung surgery and facilitate the apparent need for the continued improvement of postoperative pain management following this procedure.

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The retrospective study of perioperative application of dexamethasone and furosemide for postoperative anti-inflammation in patients undergoing percutaneous nephrolithotomy

International Urology and Nephrology ◽

10.1007/s11255-020-02718-1 ◽

2021 ◽

Author(s):

Taiguo Qi ◽

Xia Qi ◽

Xiude Chen ◽

Xunbo Jin

Keyword(s):

Clinical Outcome ◽

Hospital Stay ◽

Percutaneous Nephrolithotomy ◽

Inflammatory Markers ◽

Serum Levels ◽

Postoperative Hospital Stay ◽

Lower Serum ◽

Combined Application ◽

Furosemide Administration ◽

Anti Inflammation

Abstract Objectives To investigate whether the perioperatively combined application of dexamethasone and furosemide could alleviate the inflammation in patients undergoing percutaneous nephrolithotomy (PCNL). Patients and methods 147 patients undergoing PCNL between November 2018 and October 2019 were enrolled in the study. 77 patients accepted a single dose of dexamethasone and furosemide administration (EXP group, n = 77), and 70 patients did not (CON group, n = 70). Demographic and perioperative data, inflammatory markers including interleukin-6 (IL-6) and procalcitonin (PCT), and clinical outcomes were compared between the two groups. Results Compared with the CON group, the incidence rate of urosepsis of the EXP group were significantly lower (11.69% vs. 24.29%, p = 0.046). 3 patients developed severe urosepsis in the EXP group, while 5 patients developed severe urosepsis in the CON group. Compared with those in the CON group, the patients with postoperative urosepsis in the EXP group showed lower serum levels of IL-6 at postoperative hour two (p = 0.045) and at postoperative day one (p = 0.031) and lower serum levels of PCT at postoperative day one (p = 0.015). There was a better clinical outcome of a shorter postoperative hospital stay (p = 0.015) in patients with postoperative urosepsis in the EXP group than in those in the CON group. Conclusion The perioperatively combined application of dexamethasone and furosemide was beneficial for alleviating postoperative inflammatory reaction and caused a better clinical outcome of a shorter postoperative hospital stay.

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Early oral feeding is safe and useful after rectosigmoid resection with anastomosis during cytoreductive surgery for primary ovarian cancer

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02186-6 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Kazuyoshi Kato ◽

Kohei Omatsu ◽

Sanshiro Okamoto ◽

Maki Matoda ◽

Hidetaka Nomura ◽

...

Keyword(s):

Ovarian Cancer ◽

Hospital Stay ◽

Anastomotic Leakage ◽

Cytoreductive Surgery ◽

Group Versus ◽

Postoperative Hospital Stay ◽

Oral Feeding ◽

Early Oral Feeding ◽

Rectosigmoid Resection ◽

Primary Ovarian Cancer

Abstract Background The aim of this study was to investigate the safety and clinical usefulness of early oral feeding (EOF) after rectosigmoid resection with anastomosis for the treatment of primary ovarian cancer. Methods We performed a retrospective review of all consecutive patients who had undergone rectosigmoid resection with anastomosis for primary ovarian, tubal, or peritoneal cancer between April 2012 and March 2019 in a single institution. Patient-related, disease-related, and surgery-related data including the incidence of anastomotic leakage and postoperative hospital stay were collected. EOF was introduced as a postoperative oral feeding protocol in September 2016. Before the introduction of EOF, conventional oral feeding (COF) had been used. Results Two hundred and one patients who underwent rectosigmoid resection with anastomosis, comprised of 95 patients in the COF group and 106 patients in the EOF group, were included in this study. The median number of postoperative days until the start of diet intake was 5 (range 2–8) in the COF group and 2 (range 2–8) in the EOF group (P < 0.001). Postoperative morbidity was equivalent between the groups. The incidence of anastomotic leakage was similar (1%) in both groups. The median length of the postoperative hospital stay was reduced by 6 days for the EOF group: 17 (range 9–67) days for the COF group versus 11 (8–49) days for the EOF group (P < 0.001). Conclusion EOF provides a significant reduction in the length of the postoperative hospital stay without an increased complication risk after rectosigmoid resection with anastomosis as a part of cytoreductive surgery for primary ovarian cancer.

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