Background & Aims
Enhanced Recovery After Surgery (ERAS) programs are multimodal perioperative care pathways that aim to achieve early recovery after surgical procedures by maintaining preoperative organ function and reducing the profound stress response following surgery. One key element is multimodal and preemptive analgesia with minimal side effects to achieve important ERAS milestones such as early mobilization and oral feeding. The aim of this study was to evaluate an existing ERAS pain management protocol wherein only oral pain medications were given for pre-emptive analgesia and postoperative pain management with a goal of minimizing opioid use in a tertiary teaching hospital in Metro Manila, Philippines for 62 ERAS-enrolled patients who had undergone either open or laparoscopic sigmoidectomy.
Methods
A retrospective chart review of 62 ERAS-enrolled patients who had undergone elective open or laparoscopic sigmoid colectomy or sigmoidectomy was done. These patients were identified for inclusion using surgical procedure codes specific for open or laparoscopic sigmoidectomy. Between January 2019 and December 2023, patients who were above 18 years of age and had an American Society Association (ASA) grade of 1 to 3 were included in the study. Patients with an ASA grade of 4 to 5 and are younger than 18 years were excluded from analysis. The physical and electronic medical records of those ERAS-enrolled patients who satisfied the inclusion criteria were reviewed. The collected data were collated into a single document and were analyzed descriptively.
Results
The ERAS enrolled patients in this study were given a combination of a gabapentinoid for pre-emptive analgesia and oral Tramadol + Dexketoprofen for postoperative pain. It was found that there is a decreasing trend in numeric pain rating scale from postoperative days 0 to 2 (D0 [M = 3.35; SD = 1.66], D1 [M= 3.05; SD = 1.65], D2 [M = 2.2; SD = 1.52]). Maintaining this mild level of pain after a sigmoidectomy translates to longer ambulation times once patients are back in their rooms. The average ambulation time on day 0 was 4 hours (M = 4.14; SD 1.76). Adequate pain management also leads to shorter time to first oral feeding which is prudent in colorectal procedures to stimulate the gut and return to normal function. The average time to first oral feed was 2 days (M = 2.23; SD = 11.5). All these culminates in shorter length of stay as further management is no longer needed for these patients. The average length of stay was 4 days (M = 4.56; SD = 2.78).
Conclusions
In an ERAS setting for patients who had undergone sigmoidectomy, the administration of an opioid minimizing pain regimen effectively managed post-operative pain. By providing patients with preemptive analgesia, limiting their exposure to long-acting opioids intra-operatively and then shifting them to oral pain medications, these patients are able to achieve faster recovery from their major abdominal surgery. Specifically, they are able to return to their baseline function in terms of feeding and mobilization which in turn shortens their length of admission.
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Presenting Author
Samantha Nicole U. Roque
Poster Authors
Topics
- Models: Acute Pain