Application of principles of multimodal analgesia as the content element of a fast-track surgery program
Objective. To estimate the efficacy of postoperative pain reduction in first days after surgical intervention in acceleration of postoperative restoration in patients and reduction of the stationary treatment duration.
Materials and methods. In Sept. 2011 - May 2019 yrs period there were performed 569 elective operative interventions, using principles of a Fast Track Surgery program, including those with application of multimodal analgesia. Depending on the kind of operative intervention the indices of pain impulses were determined in accordance to visual-analogous scale and median duration of stationary treatment.
Results. On the first day after laparoscopic cholecystectomy the pain impulsation level have constituted 2.87 ± 0.74, on the second day - 2.01 ± 0.50 (p < 0.001). Median duration of the patients’ stationary stay have constituted 1.72 days. After laparoscopic hernioplasty the results of the pain level investigation were: on the first day - 3.44 ± 0.67, on the second day - 2.06 ± 0.51 (p < 0.001). Median duration of postoperative treatment have constituted 1.43 days. After laparoscopic bariatric interventions on large bowel during the first postoperative day the pain level have constituted 4.24 ± 0.75 and 4.39 ± 0.84 accordingly, on the second day it have reduced to 3.48 ± 0.57 (p < 0.001) and 3.48 ± 0.77 (p < 0.001), on the third day - to 2.79 ± 0.67 (p < 0.001) and 2.84 ± 0.69 (p < 0.001). At the same time a median duration of the patients’ stationary stay have constituted (4.99 ± 0.45) and (4.10 ± 0.60) days, accordingly.
Conclusion. Efficacy of reduction of postoperative pain in first days after surgical intervention immediately impacts the speed of restoration of the patients’ organism and duration of stationary treatment.
Gan T, Habib A, Miller T, White W, Apfelbaum J. Incidence, patient satisfaction, and perceptions of post-surgical pain: results from a US national survey. Curr Med Res Opin. 2013;30(1):149-60. doi: 10.1185/03007995.2013.860019.
Kehlet H, Dahl J. The value of «multimodal» or «balanced analgesia» in postoperative pain treatment. Anesth Analg. 1993;77(5):1048-56. doi: 10.1213/00000539-199311000-00030.
Upp J, Kent M, Tighe P. The evolution and practice of acute pain medicine. Pain Med. 2013;14(1):124-144. doi: 10.1111/pme.12015.
Kehlet H, Wilmore D. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg. 2008;248(2):189-98. doi: 10.1097/SLA.0b013e31817f2c1a.
Bujedo MB, Santos GS, Azpiazu UA, Noriega RA, Salazar GD, Andueza AM. Multimodal analgesia for the management of postoperative pain. In: Racz G, editor. Pain and Treatment. In Tech Open Access Publisher; 2014; doi: 10.5772/57401.
Gritsenko K, Khelemsky Y, Kaye A, Vadivelu N, Urman R. Multimodal therapy in perioperative analgesia. Best Pract Res Clin Anaesthesiol. 2014;28(1):59-79. doi: 10.1016/j.bpa.2014.03.001.
Wick E, Grant M, Wu C. Postoperative multimodal analgesia pain management with nonopioid analgesics and techniques. JAMA Surgery. 2017;152(7):691. doi: 10.1001/jamasurg.2017.0898.
Buvanendran A, Kroin J. Multimodal analgesia for controlling acute postoperative pain. Curr Opin Anaesthesiol. 2009;22(5):588-93. doi: 10.1097/ACO.0b013e328330373a.
Young A, Buvanendran A. Recent advances in multimodal analgesia. Anesthesiol Clin. 2012;30(1):91-100. doi: 10.1016/j.anclin.2011.12.002
Tan M, Law L, Gan T. Optimizing pain management to facilitate Enhanced Recovery After Surgery pathways. Can J Anesth. 2014;62(2):203-18. doi: 10.1007/s12630-014-0275-x.
Burton T, Mittal A, Soop M. Nonsteroidal anti-inflammatory drugs and anastomotic dehiscence in bowel surgery. Dis Colon Rectum. 2013;56(1):126-34. doi: 10.1097/DCR.0b013e31825fe927.
Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997;78(5):606-17. doi: 10.1093/bja/78.5.606.
Babina Y, Konoplitsky V, Kalinchuk O, Dmytriiev D, Nazarchuk O, Andriets E. Experience in the local use of 0.25% bupivacaine for the treatment of postoperative pain. Pain med. 2019;4(1):17-23. doi: 10.31636/pmjua.v4i1.2.
Rosero E, Joshi G. Preemptive, preventive, multimodal analgesia. Plast Reconstr Surg. 2014;134(4 Suppl 2):85S-93S. doi: 10.1097/PRS.0000000000000671.
Klein M. Postoperative non-steroidal anti-inflammatory drugs and colorectal anastomotic leakage. NSAIDs and anastomotic leakage. Dan Med J. 2012 Mar;59(3):B4420. PMID: 22381097.
Ong C, Seymour R, Lirk P, Merry A. Combining paracetamol (acetaminophen) with nonsteroidal antiinflammatory drugs: a qualitative systematic review of analgesic efficacy for acute postoperative pain. Anesth Analg. 2010; 110(4): 1170-9. doi: 10.1213/ANE.0b013e3181cf9281.
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