Using the principles of multimodal analgesia as a component of Fast-Track surgery in practice
Keywords:fast track surgery, reduction of postoperative pain
Aim. To evaluate the effectiveness of reducing postoperative pain in the first days after surgery in accelerating postoperative recovery of patients and reducing the length of stay in hospital.
Materials and methods. In the period from September 2011 to May 2019 we performed 569 scheduled surgeries using the Fasttrack surgery principles, including MMA. Depending on the type of surgery, we defined VAS pain impulses indicators and the average stay in hospital.
Results. Analyzing the impulses of pain after laparoscopic cholecystectomy in the first postoperative day (POD) VAS level was 2.87 ± 0.74, the second POD – 2.01 ± 0.50 (p < 0.001). The average hospital stay was 1.72 days. In laparoscopic hernioplasty, the results of the study of the level of pain according to VAS were as follows: the first POD – 3.44 ± 0.67, the second POD – 2.06 ± 0.51 (p < 0.001). The average hospital stay was 1.43 days after surgery. Analyzing laparoscopic bariatric interventions and interventions on the large intestine the first POD level according to VAS was 4.24 ± 0.75 and 4.39 ± 0.84 respectively; the second POD – 3.48 ± 0.57 and 3.48 ± 0.77, the third POD – 2.79 ± 0.67 and 2.84 ± 0.69. When comparing the first and second PODs after bariatric interventions, the level of pain impulsion decreased to 3.48 ± 0.57 (p < 0.001), and to the third POD – to 2.79 ± 0.67 (p < 0.001). A similar tendency was observed after laparoscopic interventions on the large intestine: the second POD – the level of pain impulsion decreased 3.48 ± 0.77 (p < 0.001), the third POD – 2.84 ± 0.69 (p < 0.001). The average hospital stay was 4.99 ± 0.45 and 4.10 ± 0.60, respectively.
Conclusions. The effectiveness of reducing postoperative pain in the first days after surgery directly affects the rate of recovery of the patient and the length of stay in hospital.
Babina YN, Konoplitsky VS, Kalinchuk OO, Dmytriiev DV, Nazarchuk OA, Andriets EV. Experience in the local use of 0.25 % bupivacaine for the treatment of postoperative pain. Pain medicine [Internet]. Interdisciplinar Academy of Pain Medicine; 2019 Jun 4;4(1):17–23. Available from: https://doi.org/10.31636/pmjua.v4i1.2
Mugabure Bujedo B, González Santos S, Uría Azpiazu A, Rubín Noriega A, García Salazar D, Azkona Andueza M. Multimodal Analgesia for the Management of Postoperative Pain. Pain and Treatment [Internet]. InTech; 2014 Jul 10; Available from: https://doi.org/10.5772/57401
Burton TP, Mittal A, Soop M. Nonsteroidal Anti-inflammatory Drugs and Anastomotic Dehiscence in Bowel Surgery. Diseases of the Colon & Rectum [Internet]. Ovid Technologies (Wolters Kluwer Health); 2013 Jan;56(1):126–34. Available from: https://doi.org/10.1097/dcr.0b013e31825fe927
Buvanendran A, Kroin JS. Multimodal analgesia for controlling acute postoperative pain. Current Opinion in Anaesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 2009 Oct;22(5):588–93. Available from: https://doi.org/10.1097/aco.0b013e328330373a
Gan TJ, Habib AS, Miller TE, White W, Apfelbaum JL. Incidence, patient satisfaction, and perceptions of post-surgical pain: results from a US national survey. Current Medical Research and Opinion [Internet]. Informa Healthcare; 2013 Nov 15;30(1):149–60. Available from: https://doi.org/10.1185/03007995.2013.860019
Gritsenko K, Khelemsky Y, Kaye AD, Vadivelu N, Urman RD. Multimodal therapy in perioperative analgesia. Best Practice & Research Clinical Anaesthesiology [Internet]. Elsevier BV; 2014 Mar;28(1):59–79. Available from: https://doi.org/10.1016/j.bpa.2014.03.001
Upp J, Kent M, Tighe PJ. The Evolution and Practice of Acute Pain Medicine. Pain Medicine [Internet]. Oxford University Press (OUP); 2013 Jan;14(1):124–44. Available from: https://doi.org/10.1111/pme.12015
Kehlet H, Dahl JB. The Value of “Multimodal” or “Balanced Analgesia” in Postoperative Pain Treatment. Anesthesia & Analgesia [Internet]. Ovid Technologies (Wolters Kluwer Health); 1993 Nov;77(5):1048–1056. Available from: https://doi.org/10.1213/00000539–199311000–00030
Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. British Journal of Anaesthesia [Internet]. Elsevier BV; 1997 May;78(5):606–17. Available from: https://doi.org/10.1093/bja/78.5.606
Kehlet H, Wilmore DW. Evidence-Based Surgical Care and the Evolution of Fast-Track Surgery. Annals of Surgery [Internet]. Ovid Technologies (Wolters Kluwer Health); 2008 Aug;248(2):189–98. Available from: https://doi.org/10.1097/sla.0b013e31817f2c1a.
Klein M, Goudsmit EM, Martin JK, Luthra MG, Wells MA, Watts RP, et al. Postoperative non-steroidal anti-inflammatory drugs and colorectal anastomotic leakage. NSAIDs and anastomotic leakage. Dan Med J. 2012 Mar 16;59(3): B4420.
Ong CKS, Seymour RA, Lirk P, Merry AF. Combining Paracetamol (Acetaminophen) with Nonsteroidal Antiinflammatory Drugs: A Qualitative Systematic Review of Analgesic Efficacy for Acute Postoperative Pain. Anesthesia & Analgesia [Internet]. Ovid Technologies (Wolters Kluwer Health); 2010 Feb;1. Available from: https://doi.org/10.1213/ane.0b013e3181cf9281
Rosero EB, Joshi GP. Preemptive, Preventive, Multimodal Analgesia. Plastic and Reconstructive Surgery [Internet]. Ovid Technologies (Wolters Kluwer Health); 2014 Oct;134:85S–93S. Available from: https://doi.org/10.1097/prs.0000000000000671
Tan M, Law LS-C, Gan TJ. Optimizing pain management to facilitate Enhanced Recovery After Surgery pathways. Canadian Journal of Anesthesia/Journal canadien d’anesthésie [Internet]. Springer Science and Business Media LLC; 2014 Dec 10;62(2):203–18. Available from: https://doi.org/10.1007/s12630–014–0275-x.
Wick EC, Grant MC, Wu CL. Postoperative Multimodal Analgesia Pain Management With Nonopioid Analgesics and Techniques. JAMA Surgery [Internet]. American Medical Association (AMA); 2017 Jul 1;152(7):691. Available from: https://doi.org/10.1001/jamasurg.2017.0898.
Young A, Buvanendran A. Recent Advances in Multimodal Analgesia. Anesthesiology Clinics [Internet]. Elsevier BV; 2012 Mar;30(1):91–100. Available from: https://doi.org/10.1016/j.anclin.2011.12.002.
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