BACKGROUND:
An ERAS program (Enhance Recovery After Surgery) is based on the decreasement of surgical damage what leads to a reduction of morbidity, mortality, complications, length of hospital stay and costs. It establishes a multimodal analgesia protocol for the perioperative pain control. The aim of our study is to analyze the enhancement of the colorectal surgical patient in an ERAS program.
MATERIALS AND METHODS:
We compare two groups: group A (N: 165) were submitted in ERAS program in 2017 and group B (N: 66): an historic group where colorectal surgery (CRS) was held without ERAS program in 2015.
Group A followed a multimodal opioid-sparing analgesia protocol including: preoperative gabapentin 300 mg, intraoperative magnesium IV (30 mg/kg) and lidocaine IV (bolus 1,5mg/kg + continuous infusion 1mg/kg) and bilateral transversus abdominis plane (TAP) block. Group B analgesia was intraoperative opioids and NSAID without premedication. In laparotomies an epidural catheter was placed in both groups (except contraindication, impossibility or laparoscopies converted to laparotomies).
Medium age is 66.25±12.93 years in group A and 64.8±15.54 years in group B. Physiological and surgical CR-POSSUM are: 12.11±6.93, 8.74±1.82 in group A and 9.03±2.67, 7.44±0.86 in group B. Chronic opioids consumption is 6.2% in group A and 1.52% in group B. Length of surgery is 193.89±74.85 minutes in group A and 179.23±82.46 minutes in group B.
RESULTS AND DISCUSSION:
Laparoscopic surgery is 65% in group A and 59% in group B. In group A the analgesia protocol compliance was above 90%.
VAS score 12 hours after surgery and on the first, second and third postoperative days is: 1.60+-1.66, 2.56±2.31, 2.13±2.02, 1.68±1.74 in group A and 2.5±1.67, 2.5±1.36, 1.83±1.56, 0.94±1.39 in group B. Morphine consumption (mg) 12 hours after surgery and on the first, second and third postoperative days is: 1.94±3.92, 2.05±4.92, 1.40±4.1, 0.92±3.53 in group A and 16.13±15.09, 13.44±10.76, 11.13±14.06, 5.18±7.57 in group B.
Nauseas and vomiting occur in 18% of the patients in group A and 36.4% in group B. Ileus occurs in 14.69%of the patients in group A and 2.8% in group B. Length of hospital stay is 6.95±4.78 days in group A and 19.35±8.23 days in group B.
CONCLUSSIONS:
Multimodal analgesia is an useful protocol in perioperative pain management. It seems that opioid- sparing analgesia in an ERAS program decreases opioids consumption, side effects and the length of hospital stay.
REFERENCES:
Ljungqvist, O., Scott, M. and Fearon, K. (2017). Enhanced Recovery After Surgery. JAMA Surgery, 152(3), p.292.
Sun, Y., Li, T., Wang, N., Yun, Y. and Gan, T. (2012). Perioperative Systemic Lidocaine for Postoperative Analgesia and Recovery after Abdominal Surgery. Diseases of the Colon & Rectum, 55(11), pp.1183-1194.

07 / MULTIMODAL OPIOID-SPARING ANALGESIA PROTOCOL IN AN ERAS PROGRAM: OUR OUTCOMES.