ABSTRACT
BACKGROUND AND OBJECTIVE: A good acute pain control is necessary to achieve the main objective of Enhanced recovery After Surgery (ERAS) programs and accelerate recovery. The study objective is to evaluate postoperative (PO) acute pain, PO opioid consumption, and its association with functional recovery, after implementing a colorectal surgery ERAS program. An analysis was made as regards drugs adverse effects. METHODS: Observational cohort study on scheduled colorectal Surgery: one prospective cohort subjected to the ERAS care program, and one retrospective cohort that received traditional non-standardised care. A record was made of mean pain intensity (measured by a visual analogue scale, which classifies pain intensity from 0 to 10, from lower to higher intensity), as well as the amount of opioid consumption on the day of surgery and on the first three postoperative days, and drugs adverse effects. An analysis was made of the association between PO opioid consumption and ERAS program, and between PO opioid consumption and functional recovery. RESULTS: The study included a total of 410 patients (313 in the ERAS group and 97 in the control group). In the ERAS group, it was observed that the mean visual analogue scale was less than 2, with a smaller amount of PO opioid consumption, on each single day and the accumulated amount of the four days (4 [0-24] vs. 0 [0-4], P<.001). PO opioid consumption was associated with functional recovery (OR 0.97 [95% CI; 0.96-0.99], P=.011). No drugs adverse effects were observed. CONCLUSIONS: After implementing a colorectal Surgery ERAS program, good pain control was achieved, as well as a reduction in PO opioid consumption, which is associated with functional recovery. No drugs adverse effects were observed.
Subject(s)
Analgesics, Opioid/therapeutic use , Colon/surgery , Digestive System Surgical Procedures , Enhanced Recovery After Surgery , Pain, Postoperative/prevention & control , Rectum/surgery , Aged , Cohort Studies , Female , Humans , Male , Middle Aged , Prospective Studies , Retrospective Studies , Treatment OutcomeABSTRACT
La tromboendarterectomía pulmonar es un procedimiento infrecuente que precisa parada circulatoria para su realización, por lo que uno de sus principales riesgos son las lesiones neurológicas postoperatorias. La monitorización cerebral intra- y postoperatoria sería, por tanto, conveniente en estos procedimientos para detectar precozmente episodios de hipoperfusión, su intensidad, así como otros episodios postoperatorios de desaturación cerebral que puedan empeorar el pronóstico neurológico (AU)
Pulmonary thromboendarterectomy is an uncommon procedure and should be performed with circulatory arrest. One of the major concerns is the postoperative central neurological injuries. Perioperative brain oxygen monitoring is advisable in this surgical procedure for the early detection of brain hypoperfusion episodes and their intensity as well as any other postoperative episodes that can deteriorate the neurological outcome (AU)
Subject(s)
Humans , Male , Female , Oximetry/instrumentation , Oximetry/methods , Oximetry , Endarterectomy/methods , Shock/complications , Circulatory Arrest, Deep Hypothermia Induced/methods , Oximetry/standards , Oximetry/trends , Endarterectomy/instrumentation , Endarterectomy/standards , Postoperative Period , Perfusion/methodsABSTRACT
Pulmonary thromboendarterectomy is an uncommon procedure and should be performed with circulatory arrest. One of the major concerns is the postoperative central neurological injuries. Perioperative brain oxygen monitoring is advisable in this surgical procedure for the early detection of brain hypoperfusion episodes and their intensity as well as any other postoperative episodes that can deteriorate the neurological outcome.