Journal of laparoendoscopic & advanced surgical techniques. Part A
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J Laparoendosc Adv Surg Tech A · Sep 2017
ReviewPrehabilitation for the Enhanced Recovery After Surgery Patient.
Prehabilitation proposes that broad health interventions at the time of decision for surgery will improve the patient's starting functional status and therefore recovery. ⋯ Preoperative health interventions may improve recovery in the postoperative period and patient health years later.
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J Laparoendosc Adv Surg Tech A · Sep 2017
Understanding Enhanced Recovery After Surgery Guidelines: An Introductory Approach.
Enhanced Recovery After Surgery (ERAS®) is a multimodal, multidisciplinary approach to surgical care. The ERAS Society has issued recommendations for many surgical procedures that address best practices in preoperative, intraoperative, and postoperative management. ⋯ In this study, the general principles of the ERAS guidelines are summarized and workload is distributed among the different members of the care team. This compartmentalized approach provides an easier way to involve key personnel in the ERAS process and assigns a role for everyone in making ERAS a success.
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J Laparoendosc Adv Surg Tech A · Sep 2017
Use of Regional Anesthesia Techniques: Analysis of Institutional Enhanced Recovery After Surgery Protocols for Colorectal Surgery.
Principles of Enhanced Recovery After Surgery (ERAS®) protocols are well established, with the primary goal of optimizing perioperative care and recovery. The use of multimodal analgesia is a key component of these protocols, including regional analgesia techniques such as thoracic epidural analgesia (TEA), transversus abdominis plane (TAP), rectus sheath blocks or continuous wound infiltration (CWI)/catheters, and spinal anesthesia. We compare and contrast regional anesthesia approaches in different institutional colorectal surgery ERAS protocols. ⋯ There are both similarities and differences in regional anesthesia techniques, which may be due to institution- and provider-level factors. Most protocols advocate for TEA use, which has been associated with a lower incidence of paralytic ileus, attenuation of the surgical stress response, improved intestinal blood flow, improved analgesia, and reduction of opioid use. Use of spinal anesthesia may lead to earlier mobilization compared to TEA, and lower doses of intrathecal morphine are recommended to reduce respiratory depression. TAP blocks were indicated for laparoscopic procedures. Rectus sheath blocks, which are listed in some protocols, may provide analgesia equivalent to epidural anesthesia, while avoiding complications of TEA. CWI has been effective in reducing postoperative pain, hastening recovery, and improving pulmonary function.