SP1.1.12Post laparotomy rectal sheath catheter analgesia, systematic review

Midline laparotomy is still performed in high proportion of patients during elective and emergency procedures. Effective analgesia is essential for enhanced recovery programs especially with the focus of multi-modal opioid sparing analgesia with its benefits in reducing opiate related side effects. Many centres adopted the use of rectal sheath catheters (RSC) in all patients undergoing laparotomy, yet its use not been standardised as there is no hard evidence supporting its use. We aim from this systematic review to explore the effectiveness of RSC in post laparotomy analgesia and to compare between different techniques of insertion. We performed a systematic review in accordance with PRISMA standards. Search of electronic information data base (Medline, Embase, Cochrane, Library, Dynamed). Results (45) studies reviewed. (33) included with (1326) patients. Conclusion There is lack of high level evidence investigating RSC rule in post laparotomy analgesia, nonetheless which is the most effective technique (USS vs surgically inserted), in spite of large heterogeneity in methodology and scarcity of trials; the consensus of the reviewed studies concluded that it decreases opiates requirements by at least (70%) in patients receiving PCA and as good as ED but with less side effects.

Oncologic Surgical Care Using an Enhanced Recovery Approach

Enhanced recovery programs are multimodal, evidence-based perioperative programs designed to improve a patient’s functional recovery after surgery. Enhanced recovery programs promote standardized, multidisciplinary care throughout the perioperative course to improve patient outcomes, rather than focusing on surgical technique. It is important for nurses working in acute and critical care to be aware of the paradigm shift created by the trend toward the enhanced recovery approach. By learning more about facets of the approach, the nurse will be better prepared to adopt whatever aspects of enhanced recovery their institution implements for the surgical oncology population. An overview is provided of the potential components of enhanced recovery.

Activity Tracking After Surgery: Does It Correlate With Postoperative Complications?

Background Postoperative ambulation is an important tenet in enhanced recovery programs. We quantitatively assessed the correlation of decreased postoperative ambulation with postoperative complications and delays in gastrointestinal function. Methods Patients undergoing major abdominal surgery were fitted with digital ankle pedometers yielding continuous measurements of their ambulation. Primary endpoints were the overall and system-specific complication rates, with secondary endpoints being the time to first passage of flatus and stool, the length of hospital stay, and the rate of readmission. Results 100 patients were enrolled. We found a significant, independent inverse correlation between the number of steps on the first and second postoperative days (POD1/2) and the incidence of complications as well as the recovery of GI function and the likelihood of readmission ( P < .05). POD2 step count was an independent risk factor for severe complications ( P = .026). Discussion Digitally quantified ambulation data may be a prognostic biomarker for the likelihood of severe postoperative complications.

Enhanced Recovery Programs for Colorectal Surgery and Postoperative Acute Kidney Injury: Results From a Systematic Review and Meta-Analysis of Observational Studies

Background Enhanced recovery programs (ERPs) for colorectal surgery bundle evidence-based measures to reduce complications, accelerate postoperative recovery, and improve the value of perioperative health care. Despite these successes, several recent studies have identified an association between ERPs and postoperative acute kidney injury (AKI). We conducted a systematic review and meta-analysis to determine the association between ERPs for colorectal surgery and postoperative AKI. Methodology After conducting a search of major databases (PubMed, Embase, Scopus, Google Scholar, and ScienceDirect), we conducted a meta-analysis of observational studies that reported on the association between ERPs and postoperative AKI. Results Six observational studies (n = 4765 patients) comparing ERP (n = 2140) to conventional care (n = 2625) were included. Overall, ERP patients had a significantly greater odds of developing postoperative AKI (odds ratio [OR] = 1.98, 95% confidence interval [CI] 1.31-3.00, P = .001) than those who received conventional care. There was no evidence of publication bias (Begg’s test P = 1.0, Egger’s P value = .95). Conclusions Based upon pooled results from observational studies, ERPs are associated with increased odds of developing postoperative AKI compared to conventional perioperative care. The mechanism for this effect is likely multifactorial. Additional research targeting high risk patient populations should evaluate the role of restrictive fluid administration, hemodynamic goals, and scheduled nephrotoxic agents in ERP protocols.