Effectiveness of ESPITO analgesia in enhancing recovery in patients undergoing open radical cystectomy when compared to a contemporaneous cohort receiving standard analgesia: an observational study
| Autor: | Zubair Tariq, Mehar Ahson, Ashani Ratnayake, Yehia Kamel, G Niraj, Vipul Kaushik, Benjamin L Jackson |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_treatment
Analgesic 030232 urology & nephrology Cystectomy 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology Humans Pain Management Medicine Prospective Studies Prospective cohort study Early discharge business.industry Patient-controlled analgesia Analgesia Patient-Controlled Analgesics Opioid Anesthesiology and Pain Medicine Opioid Anesthesia Morphine Neurology (clinical) Tramadol business medicine.drug |
| Zdroj: | Scandinavian Journal of Pain. 21:339-344 |
| ISSN: | 1877-8879 1877-8860 |
| DOI: | 10.1515/sjpain-2020-0118 |
| Popis: | Objectives Bowel dysfunction is a major complication following open surgery for invasive cancer of the bladder that results in significant discomfort; complications and can prolong the length of stay. The incidence of postoperative ileus following open radical cystectomy has been reported as 23–40%. The median length of hospital stay after this surgery in the United Kingdom is 11 days. Standard analgesic techniques include wound infusion analgesia combined with systemic morphine or thoracic epidural analgsia. Combined erector spinae plane and intrathecal opioid analgesia is a novel technique that has been reported to be an effective method of providing perioperative analgesia thereby enhancing recovery after open radical cystectomy. Methods We performed a prospective study on the effectiveness of the novel analgesic technique (combined erector spinae plane and intrathecal opioid analgesia) in reducing the incidence of postoperative ileus, thereby facilitating early discharge following open radical cystectomy when compared to a contemporaneous control group receiving standard analgesia. Twenty-five patients received the novel analgesia while 31 patients received standard analgesia as a part of enhanced recovery programme. Standard analgesia arm included 14 patients who recived thoracic epidural analgesia (14/31, 45%) and 17 patients who received combined wound infusion analgesia and patient controlled analgesia with morphine (17/31, 55%). Primary outcome was the incidence of postoperative ileus. Secondary outcomes included length of hospital stay, tramadol consumption and time to bowel opening. Results Combined erector spinae plane and intrathecal opioid analgesia was associated with a reduced incidence of postoperative ileus (16 [4/25] vs. 65% [20/31], p Conclusions ESPITO was successful in reducing postoperative ileus and length of hospital stay after open radical cystectomy when compared to standard analgesia within an enhanced recovery programme. |
| Databáze: | OpenAIRE |
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