English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

An early recovery after surgery (ERAS) program on laparoscopic colectomy with preoperative transversus abdominis plane (TAP) block was initiated to improve post-anesthesia care unit (PACU) turnover and optimize pain control. This study aims to investigate the role of opioids in pain control in such patients. Methods: A retrospective chart review was performed on patients with versus without TAP blocks. Results: Patients who had preoperative TAP blocks received significantly less long-acting opioids intraoperatively as well as perioperatively with intraoperative and PACU opioids combined (p < 0.001), but the PACU long-acting opioids requirements were similar between the two groups (p = 0.96). In addition, this program neither reduced the PACU recovery time nor cut down the length of hospital stays. Conclusions: Intraoperative opioids are still indicated/indispensable though the requirement may be much lower in certain abdominal procedures in the presence of specific peripheral nerve blockade. into this endeavor, the charge nurse in PACU stated that all TAP blocks in ERAS failed and ERAS patients needed as much opioids as non-ERAS patients and occasionally had even longer stays in PACU. An investigation was initiated immediately for better pain control and improving patient care. The outcomes of our investigation are reported below. Materials and Methods With institutional IRB approval, a retrospective chart review was performed on 40 and 28 patients immediately prior to and after ERAS implementation, respectively. The only management difference between the ERAS vs. non-ERAS group was with vs. without preoperative TAP blocks. All TAP blocks were performed or supervised by a regional anesthesia-fellowship trained attending anesthesiologist under ultrasound guidance. Each EARS patient received 10 ml liposomal bupivacaine plus 10 ml 0.25% bupivacaine on each side. Inclusion Criteria: (1) Elective laparoscopic colectomy; (2) Operated by the same surgeon Dr. J. A. Exclusion Criteria: (1) Chronic usage of opioids, gabapentinoids or any other pain-modulating medications prior to surgery; (2) Contraindications to TAP blocks; (3) Patients who received other type of opioids in addition to fentanyl and hydromorphone (the most commonly used in our institute), or ketamine or dexmedetomidine or NSAIDs, perioperatively; (4) Any perioperative complications during this hospital stay. Statistical Analysis Unless otherwise noted, Wilcoxon rank sum test or Fisher’s exact test p-value is presented. To handle the excessive zeros (1/40 vs. 18/28 in ESRA vs. non-ESRA) in the data, a finite mixture (logistic-lognormal) model was also fit, in which age, BMI, and gender were adjusted for. All statistical analyses were performed using the statistical software SAS v9.4 (Cary, NC). A Bonferroni-corrected p-value (for 10 multiple tests) of less than 0.05 was considered to be statistically significant. Introduction Early recovery after surgery (ERAS) as a form of health care standardization is value-based and evidence-driven. Multiple studies have demonstrated the efficacy of ERAS protocols in colorectal surgeries in the format of less perioperative complications and shorter length of hospital stays [1,2]. Pain control in colorectal surgeries is particularly important as inadequate analgesia has negative impacts on patient satisfaction and ambulation, yet opioids and their documented effects of delaying bowl function returning after surgery can be associated with prolonged length of hospital stays. A trial of ERAS in laparoscopic colectomy was initiated in an academic institute with the goals to: (1) Optimize perioperative pain control by emphasizing opioids sparing techniques and integrating preoperative transversus abdominis plane (TAP) blocks [3]; (2) Improve PACU turn over; (3) Decrease length of hospital stays; (4) Improve patient satisfaction. However, a couple of months

Reevaluating Withholding Intraoperative Opioids: A Lesson Learned from Visceral Pain Control in Laparoscopic Colectomy with TAP Block