Our experience in perioperative medicine in patients with colorectal surgery

Abstract

Aim: ERAS (Enhanced Recovery After Surgery) programmes have been becoming more important day by day. Researchers should compose convenient programmes according to the conditions of surgical centers. In this study we aimed to demonstrate our experience on enhanced recovery protocol. Material and Methods: Walking and respiratory excercises for physical status and information meetings with patients and relatives for mental status were done to optimize the patient before operation. Patients were received perioperative central block (either spinal or epidural) analgesia. After operation patients were followed up at surgical intensive care unit and surgery ward. Pain scores and clinical status of the patients were evaluated. Results: A total of 65 patients were included in this retrospective study. Numerical Rating Scale scores were significantly lower in thoracal epidural analgesia than spinal analgesia at 6., 12., 24., 48. hours (p=0.036; p=0.002; p=0.002; p=0.003 respectively). Early mobilizated patients oral intake and first floating time were much earlier. Conclusions: We determined positive qualitative clinical impacts on patients. Controlling patients pain at postoperative period is very important part of an enhanced recovery programme. Our protocol was about colorectal surgeries but we believe that enhanced recovery programmes should be used in different types of surgeries widespread. Keywords: Colorectal surgeries; enhanced recovery; pain; spinal; thoracal epidural

Keywords

• Colorectal surgeries
• enhanced recovery
• pain
• spinal
• thoracal epidural

References

1. 1) İlter H. Keskinkılıç B. 2015 Yılı İlk 10 Kanser. Türkiye Kanser İstatistikleri 2015, Halk Sağlığı Genel Müdürlüğü, Sağlık Bakanlığı, Ankara: 2018. 2) Mamidanna R, Burns EM, Bottle A et al. Reduced risk of medical morbidity and mortality in patients selected for laparoscopic colorectal resection in England: a population-based study. Arch Surg 2012; 147 (3): 219-27. 3) Casanova MPR. Time to change the objectives hemodynamic to guide the perioperative fluid management? Glob J Perioperative Med 2017; 1 (1): 1-3. 4) Fawcett WJ, Mythen MG, Scott MJP. Enhanced recovery: more than just reducing length of stay? Br J Anaesth 2012; 109 (5): 671-74. 5) Bozkırlı BO, Gündoğdu RH, Ersoy PE, Akbaba S, Temel H, Sayın T. Did the ERAS protocol affect our results in colorectal surgery? Ulus Cerrahi Derg 2012; 28 (3): 149-52. 6) Ersoy E, Gündoğdu H. Enhanced recovery after surgery. Ulus Cerrahi Derg 2007; 23 (1): 35-40.
2. 7) Levy N, Mills P, Mythen M. Is the pursuit of dreaming (drinking, eating and mobilising) the ultimate goal of anaesthesia? Anaesthesia 2016; 71: 1008-12. 8) Wind J, Hofland J, Benedikt P et al. Perioperative strategy in colonic surgery: LAparoscopy and/or FAst track multimodal management versus standart care (LAFA trial). BMC Surg 2006; 6: 16. 9) Yamada T, Hayashi T, Haruhiko C et al. Usefullness of enhanced recovery after surgery protocol as compared with conventional perioperative care in gastric surgery. Gastric Cancer 2012; 15: 34-41. 10) Süren M, Doğru S, Önder Y et al. The evaluation of symptom clusters in patients with the diagnosis of terminal stage cancer. Agri 2015; 27 (1): 12-7. 11) Levy BF, Scott MJP, Fawcett WJ, Day A, Rockall TA. Optimizing patient outcomes in laparoscopic surgery. Colorectal Dis 2011; 13: 8-11. 12) Ayvaz H, Düger C, Bulut F et al. Effects of pre-emptive intravenous, spinal and epidural morphine on early postoperative analgesia and stress response. Cumhuriyet Med J 2013; 35: 363-72. 13) Levy BF, Scott MJ, Fawcett W, Fry C, Rockall TA. Randomized clinical trial of epidural, spinal or patient-controlled analgesia for patients undergoing laparoscopic colorectal surgery. Br J Surg 2011; 98 (8): 1068-78. 14) Fares KM, Mohamed SA, Abdel-Ghaffar HS. High dose intratecal morphine for major abdominal cancer surgery: a prospective double-blind, dose-finding clinical study. Pain Physician 2014; 17 (3): 255-64. 15) Carli F, Baldini G. Perioperative Pain Management & Enhanced Outcomes. In: Butterworth JF, David MC, Wasnick JD (editors). Morgan&Mikhail’s Clinical Anesthesiology. 5th ed. McGraw-Hill; 2013. pp.1087-105 16) Jabbari A, Alijanpour E, Mir M, Hashem NB, Rabiea SM, Rupani MA. Postspinal puncture headache, and old problem and new concepts: review of articles about predisposing factors. Caspian J Intern Med 2013; 4 (1): 595-602 17) Turnbull DK, Shepherd DB. Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth 2003; 91 (5): 718-29. 18) Barclay KL, Zhu YY, Tacey MA. Nausea, vomiting and return of bowel function after colorectal surgery. ANZ J Surg 2015; 85: 823-8. 19) Pearse EO, Caldwell BF, Lockwood RJ, Hollard J. Early mobilisation after conventional knee replacement may reduce the risk of postoperative venous thromboembolism. J Bone Joint Surg Br 2007; 89: 316-22 20) Muehling BM, Halter GL, Schelzig H et al. Reduction of postoperative pulmonary complications after lung surgery using a fast track clinical pathway. Eur J Cardiothorac Surg 2008; 34: 174-80. 21) Huang J. Enhanced recovery after surgery (ERAS) protocols and perioperative lung protection. J Anesth Perioper Med 2014; 1: 50-6. 22) Bugada, D, Bellini V, Fanelli A et al. Future perspectives of ERAS: a narrative review on the new applications of an established approach. Surg Res Pract 2016; Article ID: 3561249. 23) Kelliher L, Jones C, Day A. Optimising perioperative patient care: ‘enhanced recovery’ following colorectal surgery. J Perioper Prac 2011; 21 (7): 239-43. 24) Kelliher LJS, Jones CN, Fawcett WJ. Enhanced recovery for gastrointestinal surgery. BJA Educ 2015; 15 (6): 305-10. 25) Bayar ÖÖ, Bademci R, Sözener U, Tüzüner A, Karayalçın K. Major karaciğer rezeksiyonunda ERAS protokolü. Okmeydanı Tıp Dergisi 2013; 29 (3): 135-42.