Email Alert RSS
Volume 9 Issue 6
. 
Turn off MathJax
Article Contents
Article Navigation >  Medical Journal of Peking Union Medical College Hospital  > 2018  >  9(6): 539-545
Yi WANG, Xian-lin HAN, Wei CHEN, Hui-yu YAN, Lei WANG, Li-jian PEI, Meng-hua DAI, Zhi-yong ZHANG, Yu-guang HUANG. Application of Different Perioperative Anesthesia Plans and Multimodal Analgesia in Enhanced Recovery after Surgery for Open Pancreaticoduodenectomy[J]. Medical Journal of Peking Union Medical College Hospital, 2018, 9(6): 539-545. doi: 10.3969/j.issn.1674-9081.2018.06.010
Citation: Yi WANG, Xian-lin HAN, Wei CHEN, Hui-yu YAN, Lei WANG, Li-jian PEI, Meng-hua DAI, Zhi-yong ZHANG, Yu-guang HUANG. Application of Different Perioperative Anesthesia Plans and Multimodal Analgesia in Enhanced Recovery after Surgery for Open Pancreaticoduodenectomy[J]. Medical Journal of Peking Union Medical College Hospital, 2018, 9(6): 539-545. doi: 10.3969/j.issn.1674-9081.2018.06.010
shu

Application of Different Perioperative Anesthesia Plans and Multimodal Analgesia in Enhanced Recovery after Surgery for Open Pancreaticoduodenectomy

doi: 10.3969/j.issn.1674-9081.2018.06.010
  • 1.

    Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

  • 2.

    Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

  • 3.

    Department of Enteral and Parenteral Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

More Information
  • Corresponding author: DAI Meng-hua  Tel:010-69152603, E-mail :daim66@126.com; ZHANG Zhi-yong  Tel:010-69152020, E-mail :13810700759@163.com
  • Received Date: 2018-08-01
  • Publish Date: 2018-11-30
    Abstract
  •   Objective   This study aimed to evaluate the safety and effectiveness of different anesthetic approaches and multimodal analgesia in enhanced recovery after surgery (ERAS) when applied to open pancreaticoduodenectomy patients.   Methods   In this retrospective cohort study, we consecutively collected clinical data from 39 patients undergoing open pancreaticoduodenectomy in Peking Union Medical College Hospital from March 2016 to April 2018, among which 19 patients received ERAS strategy (ERAS group) and 20 traditional strategy (control group), and compared the differences in intra-operative hemodynamic changes, post-operative rehabilitation, length of stay, and costs between the ERAS group and the control group.   Results   The intraoperative opioid consumption and postoperative lactic acid in the ERAS group were lower than those in the control group (both P < 0.05). White blood cell and neutrophil counts on the postoperative day 1, blood glucose, pain score, postoperative nausea and vomiting, postoperative analgesia satisfaction, time to remove the transurethral catheter and nasogastric tube, time to exhaust and ambulation, and medical costs were all improved compared to the control group (all P < 0.05). Whereas operating duration, intraoperative hemodynamic changes, and intraoperative bleeding were comparable between the two groups (all P>0.05).   Conclusion   Different perioperative anesthesia plans and multimodal analgesia in ERAS strategy are safe when applied to open pancreaticoduodenectomy patients. It could effectively mitigate operative stress, decrease opioid exposure, expedite postoperative rehabilitation, shorten the length of hospital stay, and decrease medical cost.
    • FullText(HTML)
  • loading
    • References(30)
  • [1] Wilmore DW, Kehlet H. Management of patients in fast track surgery[J]. BMJ, 2001, 322:473-476. doi:  10.1136/bmj.322.7284.473
    [2] Ljungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery:A Review[J]. JAMA Surg, 2017, 152:292-298. doi:  10.1001/jamasurg.2016.4952
    [3] Karran A, Wheat J, Chan D, et al. Propensity score analysis of an enhanced recovery programme in upper gastrointestinal cancer surgery[J]. World J Surg, 2016, 40:1645-1654. doi:  10.1007/s00268-016-3473-6
    [4] Sutherasan M, Taesombat W, Sirichindakul B, et al. Improving the surgical outcomes after liver resection with ERAS program[J]. J Med Assoc Thai, 2017, 100:435-440.
    [5] Kent M, Calvert N, Blades K, et al. Enhanced recovery principles applied to revision hip and knee arthroplasty reduces length of stay and blood transfusion[J]. J Orthop, 2017, 14:555-560. doi:  10.1016/j.jor.2017.08.012
    [6] Tan NLT, Hunt JL, Gwini SM. Does implementation of an enhanced recovery after surgery program for hip replacement improve quality of recovery in an Australian private hospital:a quality improvement study[J]. BMC Anesthesiol, 2018, 18:64. doi:  10.1186/s12871-018-0525-5
    [7] Barber EL, Van Le L. Enhanced recovery pathways in gynecology and gynecologic oncology[J]. Obstet Gynecol Surv, 2015, 70:780-792. doi:  10.1097/OGX.0000000000000259
    [8] Collins JW, Patel H, Adding C, et al. Enhanced recovery after robot-assisted radical cystectomy:EAU robotic urology section scientific working group cnsensus view[J]. Eur Urol, 2016, 70:649-660. doi:  10.1016/j.eururo.2016.05.020
    [9] Lassen K, Coolsen MM, Slim K, et al. Guidelines for perioperative care for pancreaticoduodenectomy:Enhanced Reco-very After Surgery (ERAS(R)) Society recommendations[J]. Clin Nutr, 2012, 31:817-830. doi:  10.1016/j.clnu.2012.08.011
    [10] Liu Z, Peneva IS, Evison F, et al. Ninety day mortality following pancreatoduodenectomy in England:has the optimum centre volume been identified?[J]. HPB (Oxford), 2018. doi: 10.1016/j.hpb.2018.04.008.[Epub ahead of print].
    [11] Das BC, Khan AS, Elahi NE, et al. Morbidity and mortality after pancreatoduodenectomy:a five year eperience in Bangabandhu Sheikh Mujib Medical University[J]. Mymensingh Med J, 2017, 26:145-153.
    [12] Amini A, Patanwala AE, Maegawa FB, et al. Effect of epidural analgesia on postoperative complications following pancreaticoduodenectomy[J]. Am J Surg, 2012, 204: 1000-1004, discussion 4-6.
    [13] Hutchins JL, Grandelis AJ, Kaizer AM, et al. Thoracic paravertebral block versus thoracic epidural analgesia for post-operative pain control in open pancreatic surgery:A randomized controlled trial[J]. J Clin Anesth, 2018, 48:41-45. doi:  10.1016/j.jclinane.2018.04.013
    [14] Gerritsen A, Besselink MG, Gouma DJ, et al. Systematic review of five feeding routes after pancreatoduodenectomy[J]. Br J Surg, 2013, 100: 589-598, discussion 99.
    [15] Lassen K, Coolsen MM, Slim K, et al. Guidelines for perioperative care for pancreaticoduodenectomy:Enhanced Recovery After Surgery (ERAS(R)) Society recommendations[J]. World J Surg, 2013, 37:240-258. doi:  10.1007/s00268-012-1771-1
    [16] Mezhir JJ. Management of complications following pancreatic resection:an evidence-based approach[J]. J Surg Oncol, 2013, 107:58-66. doi:  10.1002/jso.23139
    [17] Agarwal A, Pandey R, Dhiraaj S, et al. The effect of epidural bupivacaine on induction and maintenance doses of propofol (evaluated by bispectral index) and maintenance doses of fentanyl and vecuronium[J]. Anesth Analg, 2004, 99: 1684-1688, table of contents.
    [18] Mcevoy MD, Scott MJ, Gordon DB, et al. American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on optimal analgesia within an enhanced recovery pathway for colorectal surgery:part 1-from the preoperative period to PACU[J]. Perioper Med (Lond), 2017, 6:8. doi:  10.1186/s13741-017-0064-5
    [19] Long DR, Lihn AL, Friedrich S, et al. Association between intraoperative opioid administration and 30-day readmission:a pre-specified analysis of registry data from a healthcare network in New England[J]. Br J Anaesth, 2018, 120:1090-1102. doi:  10.1016/j.bja.2017.12.044
    [20] Du KN, Feng L, Newhouse A, et al. Effects of Intraoperative Opioid Use on Recurrence-Free and Overall Survival in Patients With Esophageal Adenocarcinoma and Squamous Cell Carcinoma[J]. Anesth Analg, 2018, 127:210-216. doi:  10.1213/ANE.0000000000003428
    [21] Daudel F, Ertmer C, Stubbe HD, et al. Hemodynamic effects of thoracic epidural analgesia in ovine hyperdynamic endotoxemia[J]. Reg Anesth Pain Med, 2007, 32:311-316. doi:  10.1097/00115550-200707000-00007
    [22] Radovanovic D, Radovanovic Z, Skoric-Jokic S, et al. Thoracic Epidural Versus Intravenous Patient-Controlled Analg-esia after Open Colorectal Cancer Surgery[J]. Acta clinica Croatica, 2017, 56:244-254.
    [23] Lee JH, Park JH, Kil HK, et al. Efficacy of intrathecal morphine combined with intravenous analgesia versus thoracic epidural analgesia after gastrectomy[J]. Yonsei Med J, 2014, 55:1106-1114. doi:  10.3349/ymj.2014.55.4.1106
    [24] Partelli S, Crippa S, Castagnani R, et al. Evaluation of an enhanced recovery protocol after pancreaticoduodenectomy in elderly patients[J]. HPB (Oxford), 2016, 18:153-158. doi:  10.1016/j.hpb.2015.09.009
    [25] Koller SE, Bauer KW, Egleston BL, et al. Comparative Effectiveness and Risks of Bowel Preparation Before Elective Colorectal Surgery[J]. Ann Surg, 2018, 267:734-742. doi:  10.1097/SLA.0000000000002159
    [26] Lavu H, Kennedy EP, Mazo R, et al. Preoperative mech-anical bowel preparation does not offer a benefit for patients who undergo pancreaticoduodenectomy[J]. Surgery, 2010, 148:278-284. doi:  10.1016/j.surg.2010.03.012
    [27] Singh BN, Dahiya D, Bagaria D, et al. Effects of preo-perative carbohydrates drinks on immediate postoperative outcome after day care laparoscopic cholecystectomy[J]. Surg Endosc, 2015, 29:3267-3272. doi:  10.1007/s00464-015-4071-7
    [28] Bernard H. Patient warming in surgery and the enhanced recovery[J]. Br J Nurs, 2013, 22:319-320, 322-325. doi:  10.12968/bjon.2013.22.6.319
    [29] Gustafsson UO, Scott MJ, Schwenk W, et al. Guidelines for perioperative care in elective colonic surgery:Enhanced Recovery After Surgery (ERAS(R)) Society recommenda-tions[J]. Clin Nutr, 2012, 31:783-800. doi:  10.1016/j.clnu.2012.08.013
    [30] Kwaan MR, Lee JT, Rothenberger DA, et al. Early removal of urinary catheters after rectal surgery is associated with increased urinary retention[J]. Dis Colon Rectum, 2015, 58:401-405. doi:  10.1097/DCR.0000000000000317
    • Relative Articles(0)
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(1)  / Tables(4)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (313) PDF downloads(237) Cited by()
    Proportional views
    Related
    Links: National Health Commission of the People's Republic of China Chinese Academy of Medical Sciences(CAMS) AMLC Check CNKI Database CNKI Term Online Chinese General Practice
    Address：Room 302,Third Floor,Building 7, No. 1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing 100730, China
    Tel：010-69154261/4262
    E - mail：medj@pumch.cn
    mjpumch@126.com
    Copyright of website：Editorial Office of Medical Journal of Peking Union Medical College Hospital

    Supported by: Beijing Renhe Information Technology Co. Ltd    

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return