The optimal pain management for an Enhanced Recovery program for 23-hour stay after surgery for colon cancer
EAES Academy. Sier M. 07/05/22; 362992; P035
Ms. Misha Sier
Contributions
Contributions
Abstract
Background:
Introduction of the Enhanced Recovery After Surgery (ERAS) program has radically improved postoperative outcomes. Interest is rising to optimize and accelerate the enhanced recovery pathway (ERP). Optimal pain management is a crucial factor to enhance recovery. Spinal anesthesia has been introduced to decrease the postoperative pain and the need for analgesia, and to facilitate mobility. The aim of this study was to investigate the effects of spinal anesthesia with bupivacaine (Marcain) versus prilocaine prior to surgery for colon carcinoma in an accelerated enhanced recovery pathway (ERP).
Methods:
This single-center, non-randomized, prospective study was carried out in one large teaching hospital in the Netherlands. The study was conducted among patients included in the CHASE study, which included patients (≥ 18 years ≤ 80) undergoing elective laparoscopic surgical resection for colon carcinoma, and meeting the following criteria: BMI ≤ 35 kg/m2, ASA I-II, available ambulant care and available by phone. The 23-hour accelerated ERAS protocol consisted of a multidisciplinary and multifaceted protocol adjusting the pre-, peri- and postoperative care. Optimal pain management was one of the key elements. Based on inclusion number, patients received spinal anesthesia with prilocaine or Marcain.
Main study parameters/endpoints:
The primary endpoint of this study was the Visual Analogue Score (VAS) for pain postoperatively. Secondary endpoints are reported pain scores at the surgical ward and administration of analgesia, complication rates and Length of hospital Stay (LOS).
Current status:
To date 89 patients were eligible for inclusion, of whom 64 patients were included in this study, with > 80% success rate for 23-hour stay after surgery. Six patients were excluded; two patients due to conversion to an open procedure, three patients due to deviation from the anesthesia protocol, and one patient due to difference in surgical procedure. Thirty-one patients received spinal anesthesia with prilocaine, 17 patients received spinal anesthesia with Marcain. Thirty patients from the prilocaine group will be compared to 30 patients in the Marcain group. We expect to have results ready within three months from now in order to present the results on the congress.
Introduction of the Enhanced Recovery After Surgery (ERAS) program has radically improved postoperative outcomes. Interest is rising to optimize and accelerate the enhanced recovery pathway (ERP). Optimal pain management is a crucial factor to enhance recovery. Spinal anesthesia has been introduced to decrease the postoperative pain and the need for analgesia, and to facilitate mobility. The aim of this study was to investigate the effects of spinal anesthesia with bupivacaine (Marcain) versus prilocaine prior to surgery for colon carcinoma in an accelerated enhanced recovery pathway (ERP).
Methods:
This single-center, non-randomized, prospective study was carried out in one large teaching hospital in the Netherlands. The study was conducted among patients included in the CHASE study, which included patients (≥ 18 years ≤ 80) undergoing elective laparoscopic surgical resection for colon carcinoma, and meeting the following criteria: BMI ≤ 35 kg/m2, ASA I-II, available ambulant care and available by phone. The 23-hour accelerated ERAS protocol consisted of a multidisciplinary and multifaceted protocol adjusting the pre-, peri- and postoperative care. Optimal pain management was one of the key elements. Based on inclusion number, patients received spinal anesthesia with prilocaine or Marcain.
Main study parameters/endpoints:
The primary endpoint of this study was the Visual Analogue Score (VAS) for pain postoperatively. Secondary endpoints are reported pain scores at the surgical ward and administration of analgesia, complication rates and Length of hospital Stay (LOS).
Current status:
To date 89 patients were eligible for inclusion, of whom 64 patients were included in this study, with > 80% success rate for 23-hour stay after surgery. Six patients were excluded; two patients due to conversion to an open procedure, three patients due to deviation from the anesthesia protocol, and one patient due to difference in surgical procedure. Thirty-one patients received spinal anesthesia with prilocaine, 17 patients received spinal anesthesia with Marcain. Thirty patients from the prilocaine group will be compared to 30 patients in the Marcain group. We expect to have results ready within three months from now in order to present the results on the congress.
Background:
Introduction of the Enhanced Recovery After Surgery (ERAS) program has radically improved postoperative outcomes. Interest is rising to optimize and accelerate the enhanced recovery pathway (ERP). Optimal pain management is a crucial factor to enhance recovery. Spinal anesthesia has been introduced to decrease the postoperative pain and the need for analgesia, and to facilitate mobility. The aim of this study was to investigate the effects of spinal anesthesia with bupivacaine (Marcain) versus prilocaine prior to surgery for colon carcinoma in an accelerated enhanced recovery pathway (ERP).
Methods:
This single-center, non-randomized, prospective study was carried out in one large teaching hospital in the Netherlands. The study was conducted among patients included in the CHASE study, which included patients (≥ 18 years ≤ 80) undergoing elective laparoscopic surgical resection for colon carcinoma, and meeting the following criteria: BMI ≤ 35 kg/m2, ASA I-II, available ambulant care and available by phone. The 23-hour accelerated ERAS protocol consisted of a multidisciplinary and multifaceted protocol adjusting the pre-, peri- and postoperative care. Optimal pain management was one of the key elements. Based on inclusion number, patients received spinal anesthesia with prilocaine or Marcain.
Main study parameters/endpoints:
The primary endpoint of this study was the Visual Analogue Score (VAS) for pain postoperatively. Secondary endpoints are reported pain scores at the surgical ward and administration of analgesia, complication rates and Length of hospital Stay (LOS).
Current status:
To date 89 patients were eligible for inclusion, of whom 64 patients were included in this study, with > 80% success rate for 23-hour stay after surgery. Six patients were excluded; two patients due to conversion to an open procedure, three patients due to deviation from the anesthesia protocol, and one patient due to difference in surgical procedure. Thirty-one patients received spinal anesthesia with prilocaine, 17 patients received spinal anesthesia with Marcain. Thirty patients from the prilocaine group will be compared to 30 patients in the Marcain group. We expect to have results ready within three months from now in order to present the results on the congress.
Introduction of the Enhanced Recovery After Surgery (ERAS) program has radically improved postoperative outcomes. Interest is rising to optimize and accelerate the enhanced recovery pathway (ERP). Optimal pain management is a crucial factor to enhance recovery. Spinal anesthesia has been introduced to decrease the postoperative pain and the need for analgesia, and to facilitate mobility. The aim of this study was to investigate the effects of spinal anesthesia with bupivacaine (Marcain) versus prilocaine prior to surgery for colon carcinoma in an accelerated enhanced recovery pathway (ERP).
Methods:
This single-center, non-randomized, prospective study was carried out in one large teaching hospital in the Netherlands. The study was conducted among patients included in the CHASE study, which included patients (≥ 18 years ≤ 80) undergoing elective laparoscopic surgical resection for colon carcinoma, and meeting the following criteria: BMI ≤ 35 kg/m2, ASA I-II, available ambulant care and available by phone. The 23-hour accelerated ERAS protocol consisted of a multidisciplinary and multifaceted protocol adjusting the pre-, peri- and postoperative care. Optimal pain management was one of the key elements. Based on inclusion number, patients received spinal anesthesia with prilocaine or Marcain.
Main study parameters/endpoints:
The primary endpoint of this study was the Visual Analogue Score (VAS) for pain postoperatively. Secondary endpoints are reported pain scores at the surgical ward and administration of analgesia, complication rates and Length of hospital Stay (LOS).
Current status:
To date 89 patients were eligible for inclusion, of whom 64 patients were included in this study, with > 80% success rate for 23-hour stay after surgery. Six patients were excluded; two patients due to conversion to an open procedure, three patients due to deviation from the anesthesia protocol, and one patient due to difference in surgical procedure. Thirty-one patients received spinal anesthesia with prilocaine, 17 patients received spinal anesthesia with Marcain. Thirty patients from the prilocaine group will be compared to 30 patients in the Marcain group. We expect to have results ready within three months from now in order to present the results on the congress.
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