Annals of the Royal College of Surgeons of England
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Ann R Coll Surg Engl · Jul 2012
ReviewEnhanced recovery programmes in hepatobiliary and pancreatic surgery: a systematic review.
The terms 'enhanced recovery after surgery', 'enhanced recovery programme' (ERP) and 'fast track surgery' refer to multimodal strategies aiming to streamline peri-operative care pathways, to maximise effectiveness and minimise costs. While the results of ERP in colorectal surgery are well reported, there have been no reviews examining if these concepts could be applied safely to hepatopancreatobiliary (HPB) surgery. The aim of this systematic review was to appraise the current evidence for ERP in HPB surgery. ⋯ The introduction of an ERP in HPB surgery appears safe and feasible. Currently, many of the principles of the multimodal pathway are derived from the colorectal ERP and distinct differences exist, which may impede its implementation in HPB surgery.
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Ann R Coll Surg Engl · Jul 2012
Clinical TrialSafety trial of Floseal(®) haemostatic agent in head and neck surgery.
Floseal(®) can be of value in reducing blood loss and haematoma rates. The manufacturer's warnings include allergic reaction, poor wound healing and intravascular thrombosis. We aimed to determine whether Floseal(®) is safe to use in various head and neck surgery procedures. ⋯ Floseal(®) is safe to be used in head and neck surgery with no adverse effects. A larger number and a control group are required to ascertain its value in reducing blood loss, haematoma formation, drain usage and hospital stay.
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Ann R Coll Surg Engl · Jul 2012
Predicting postoperative urinary retention after lower limb arthroplasty.
A simple scoring system that enables surgeons to make an estimation of the likelihood of postoperative urinary retention (POUR) in patients undergoing lower limb total joint replacement would be a useful one. This would enable selection of high risk patients who merit pre-operative catheterisation in a clean theatre environment rather than risking urinary retention and its associated complications late at night on the ward by junior, inexperienced staff. ⋯ We found a statistically significant increase in the likelihood of POUR as IPSS rises (p = 0.0002). We concluded that the IPSS is a quick and easy method of predicting those at risk of POUR, allowing them to be catheterised prophylactically, preventing possible complications.
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Ann R Coll Surg Engl · Jul 2012
Comparative StudyClosed suction drains, reinfusion drains or no drains in primary total knee replacement?
Controversy still surrounds the use of drains after total knee replacement (TKR). We compared closed suction drains, reinfusion drains and no drains by studying haemoglobin (Hb) levels, blood transfusion requirements and functional knee outcome scores in a single surgeon series. ⋯ Our study does not support the use of either closed suction drains or reinfusion drains in primary elective TKR.
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Ann R Coll Surg Engl · Jul 2012
Open transversus abdominis plane block and analgesic requirements in patients following right hemicolectomy.
Reducing exogenously administered opioids in the post-operative period is associated with early return of bowel function and decreased post-operative complication rates. We evaluated the effectiveness of a surgeon-delivered open transversus abdominis plane (TAP) block as a method to reduce post-operative opioid requirements, sedation and inpatient stay. ⋯ Open TAP blocks are safe and reduce post-operative opioid requirements and sedation after right hemicolectomies. They should be considered as part of a multimodal enhanced recovery approach to patients undergoing abdominal surgery via a transverse incision.