Tips and tricks in achieving zero peri-operative opioid used in onco-urologic surgery.

Autor: Katims AB; Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY, 10029, USA., Eilender BM; Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY, 10029, USA., Pfail JL; Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY, 10029, USA., Sim AJ; Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Sfakianos JP; Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY, 10029, USA. john.sfakianos@mountsinai.org.
Jazyk: angličtina
Zdroj: World journal of urology [World J Urol] 2022 Jun; Vol. 40 (6), pp. 1343-1350. Date of Electronic Publication: 2020 Jun 18.
DOI: 10.1007/s00345-020-03305-w
Abstrakt: Purpose: To review non-opioid based protocols in urologic oncologic surgery and describe our institutional methods of eliminating peri-operative opioids.
Methods: A thorough literature review was performed using PUBMED to identify articles pertaining to reducing or eliminating narcotic use in genitourinary cancer surgery. Studies were analyzed pertaining to protocols utilized in genitourinary cancer surgery, major abdominal and/or pelvic non-urologic surgery.
Results: Reducing or eliminating peri-operative narcotics should begin with an institutionalized protocol made in conjunction with the anesthesia department. Pre-operative regimens should consist of appropriate counseling, gabapentin, and acetaminophen with or without a non-steroidal anti-inflammatory medications. Prior to incision, a regional block or local anesthetic should be delivered. Anesthesiologists may develop opioid-free protocols for achieving and maintaining general anesthesia. Post-operatively, patients should be on a scheduled regimen of ketorolac, gabapentin, and acetaminophen.
Conclusion: Eliminating peri-operative narcotic use is feasible for major genitourinary oncologic surgery. Patients not only have improved peri-operative outcomes but also are at significantly reduced risk of developing long-term opioid use. Through the implementation of a non-opioid protocol, urologists are able to best serve their patients while positively contributing to reducing the opioid epidemic.
(© 2020. Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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