Skip to main content
Erschienen in: European Surgery 5/2015

01.10.2015 | Original Article

Pain perception and short-term outcomes in totally laparoscopic colonic surgery with two different fast track programs

verfasst von: G. Mari, MD, P. De Martini, MD, D. Maggioni, MSI, A. Costanzi, MD, G. Ferrari, MD, S. De Carli, MD, R. Pugliese, MSI

Erschienen in: European Surgery | Ausgabe 5/2015

Einloggen, um Zugang zu erhalten

Abstract

Aim of the study

to evaluated pain perception and return to normal daily activities in two groups of patients undergoing elective totally laparoscopic colonic surgery according to two different analgesic protocols within Fast Track programs.

Method

we compared two groups of patients prospectively evaluated in terms of post-operative painperception and short term outcomes undergoing totally laparoscopic elective colonic surgery among fasttrack programs. 46 patients (43 completed the study) (Group 1) received analgesia with spinal injection 30 min before surgery of Morphine 0,2 – 0,3 mg , morphine PCA post operatively, Paracetamol 1 gr if needed every 8 h. 43 patients (40 completed the study) (Group 2) received analgesia with Paracetamol 1 gr every 6 h , ketorolac every 12 h, Lidocaine wound infiltration.

Result

Patients in G2 passed flatus and stool significantly before those in G1 (p<0,05) and were discharged significantly earlier than those in G1 (p<0,05). Return to normal daily activities was similar in the two groups.
Pain perception in the immediate post-operative period was significantly higher in patients in G2 (p<0,05).

Conclusion

Morphine free analgesia significantly improve bowel function recovery and hospitalization. Pain perception in the immediate post-operative needs to be optimized.
Literatur
1.
Zurück zum Zitat Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg. 2002;183:630–41.CrossRefPubMed Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg. 2002;183:630–41.CrossRefPubMed
2.
Zurück zum Zitat Braga M, Vignali A, Zuliani W, et al. Metabolic and functional results after laparoscopic colorectal surgery: a randomized, controlled trial. DisColon Rectum. 2002;45:1070–7.CrossRef Braga M, Vignali A, Zuliani W, et al. Metabolic and functional results after laparoscopic colorectal surgery: a randomized, controlled trial. DisColon Rectum. 2002;45:1070–7.CrossRef
3.
Zurück zum Zitat Scatizzi M, Kroning KC, Boddi V, et al. Fast track surgery after laparoscopic colorectal surgery: is it feasible in a general surgery unit? Surgery. 2009. Scatizzi M, Kroning KC, Boddi V, et al. Fast track surgery after laparoscopic colorectal surgery: is it feasible in a general surgery unit? Surgery. 2009.
4.
Zurück zum Zitat Carli F, Kehlet H, Baldini G, et al. Evidence basis for regional anesthesia in multidisciplinary fast-track surgical care pathways. Reg Anesth Pain Med. 2011;36(1):63–72.CrossRefPubMed Carli F, Kehlet H, Baldini G, et al. Evidence basis for regional anesthesia in multidisciplinary fast-track surgical care pathways. Reg Anesth Pain Med. 2011;36(1):63–72.CrossRefPubMed
5.
Zurück zum Zitat Kehlet H. Fast-track colonic surgery: status and perspectives. Recent Results Cancer Res. 2005;165:8–13.CrossRefPubMed Kehlet H. Fast-track colonic surgery: status and perspectives. Recent Results Cancer Res. 2005;165:8–13.CrossRefPubMed
6.
Zurück zum Zitat Jakobsen DH, Sonne E, Andreasen J, Kehlet H. Convalescence after colonic surgery with fast-track vs conventional care. Colorectal Dis. 2006;8(8):683–7.CrossRefPubMed Jakobsen DH, Sonne E, Andreasen J, Kehlet H. Convalescence after colonic surgery with fast-track vs conventional care. Colorectal Dis. 2006;8(8):683–7.CrossRefPubMed
7.
Zurück zum Zitat Yang D, He W, Zhang S, et al. Fast-track surgery improves postoperative clinical recovery and immunity after elective surgery for colorectal carcinoma: randomized controlled clinical trial. World J Surg. 2012;36(8):1874–80.PubMedCentralCrossRefPubMed Yang D, He W, Zhang S, et al. Fast-track surgery improves postoperative clinical recovery and immunity after elective surgery for colorectal carcinoma: randomized controlled clinical trial. World J Surg. 2012;36(8):1874–80.PubMedCentralCrossRefPubMed
8.
Zurück zum Zitat Schwenk W, Jacobi C, Mansmann U, et al. Inflammatory response after laparoscopic and conventional colorectal resections-results of a prospective randomizedtrial. Langenbecks Arch Surg. 2000;385:2–9.CrossRefPubMed Schwenk W, Jacobi C, Mansmann U, et al. Inflammatory response after laparoscopic and conventional colorectal resections-results of a prospective randomizedtrial. Langenbecks Arch Surg. 2000;385:2–9.CrossRefPubMed
9.
Zurück zum Zitat Leung KL, Kwok SP, Lam SC, et al. Laparoscopic resection of recto-sigmoid carcinoma: prospective randomized trial. Lancet. 2004;363:1187–92.CrossRefPubMed Leung KL, Kwok SP, Lam SC, et al. Laparoscopic resection of recto-sigmoid carcinoma: prospective randomized trial. Lancet. 2004;363:1187–92.CrossRefPubMed
10.
Zurück zum Zitat Jayne DG, Guillou PJ, Thorpe H, et al. UK MRC CLASICC Trial Group. Randomized trial of laparoscopic-assisted resection of colorectal lcarcinoma: 3-year results. Rectum. 1998;41:901–34. Jayne DG, Guillou PJ, Thorpe H, et al. UK MRC CLASICC Trial Group. Randomized trial of laparoscopic-assisted resection of colorectal lcarcinoma: 3-year results. Rectum. 1998;41:901–34.
11.
Zurück zum Zitat Casciola L, Ceccarelli G, Di Zitti L, et al. Laparoscopic right hemicolectomy with intracorporeal anastomosis. Technical aspects and personal experience. Minerva Chir. 2003;58:621–7.PubMed Casciola L, Ceccarelli G, Di Zitti L, et al. Laparoscopic right hemicolectomy with intracorporeal anastomosis. Technical aspects and personal experience. Minerva Chir. 2003;58:621–7.PubMed
12.
Zurück zum Zitat Bergarnaschi R, Schochet E, Haughn C, et al. Standardized laparoscopic intracorporeal right colectomy for cancer: short-term outcome in 111 unselected patients. Dis Colon Recturn. 2008;51(9):1350–5.CrossRef Bergarnaschi R, Schochet E, Haughn C, et al. Standardized laparoscopic intracorporeal right colectomy for cancer: short-term outcome in 111 unselected patients. Dis Colon Recturn. 2008;51(9):1350–5.CrossRef
13.
Zurück zum Zitat Hellan M, Anderson C, Pigazzi A. Extracorporeal versus intracorporeal anastomosis for laparoscopic right hemicolectomy. JSLS. 2009;13:312–7.PubMedCentralPubMed Hellan M, Anderson C, Pigazzi A. Extracorporeal versus intracorporeal anastomosis for laparoscopic right hemicolectomy. JSLS. 2009;13:312–7.PubMedCentralPubMed
14.
Zurück zum Zitat Lang RA, Huttl TP, Winter H, et al. How safe are intracorporeal anastomoses? Zentralbl Chir. 2005;130:65–70.CrossRefPubMed Lang RA, Huttl TP, Winter H, et al. How safe are intracorporeal anastomoses? Zentralbl Chir. 2005;130:65–70.CrossRefPubMed
15.
Zurück zum Zitat Lv L, Shao YF, Zhou YB. The enhanced recovery after surgery (ERAS) pathway for patients undergoing colorectal surgery: an update of meta-analysis of randomized controlled trials. Int J Colorectal Dis. 2012;27(12):1549-54. Lv L, Shao YF, Zhou YB. The enhanced recovery after surgery (ERAS) pathway for patients undergoing colorectal surgery: an update of meta-analysis of randomized controlled trials. Int J Colorectal Dis. 2012;27(12):1549-54.
16.
Zurück zum Zitat Feroci F, Kröning KC, Lenzi E, et al. Laparoscopy within a fast-track program enhances the short-term results after elective surgery for resectable colorectal cancer. Surg Endosc. 2011;25(9):2919–25. (Epub 2011 Mar 18.13).CrossRefPubMed Feroci F, Kröning KC, Lenzi E, et al. Laparoscopy within a fast-track program enhances the short-term results after elective surgery for resectable colorectal cancer. Surg Endosc. 2011;25(9):2919–25. (Epub 2011 Mar 18.13).CrossRefPubMed
17.
Zurück zum Zitat van Bree SH, Vlug MS, Bemelman WA, et al. Faster recovery of gastrointestinal transit after laparoscopy and fast-track care in patients undergoing colonic surgery. Gastroenterology. 2011;141(3):872–80. (e1-4. Epub 2011 May 26).CrossRefPubMed van Bree SH, Vlug MS, Bemelman WA, et al. Faster recovery of gastrointestinal transit after laparoscopy and fast-track care in patients undergoing colonic surgery. Gastroenterology. 2011;141(3):872–80. (e1-4. Epub 2011 May 26).CrossRefPubMed
18.
Zurück zum Zitat Wang Q, Suo J, Jiang J, et al. Effectiveness of fast-track rehabilitation vs conventional care in laparoscopic colorectal resection for elderly patients: a randomized trial. Colorectal Dis. 2012;14(8):1009–13.CrossRefPubMed Wang Q, Suo J, Jiang J, et al. Effectiveness of fast-track rehabilitation vs conventional care in laparoscopic colorectal resection for elderly patients: a randomized trial. Colorectal Dis. 2012;14(8):1009–13.CrossRefPubMed
19.
Zurück zum Zitat White PF, Kehlet H, Neal JM, et al. The role of the anesthesiologist in fast-track surgery: from multimodal analgesia to perioperative medical care. Anesth Analg. 2007;104(6):1380–96.CrossRefPubMed White PF, Kehlet H, Neal JM, et al. The role of the anesthesiologist in fast-track surgery: from multimodal analgesia to perioperative medical care. Anesth Analg. 2007;104(6):1380–96.CrossRefPubMed
20.
Zurück zum Zitat Kehlet H. Fast-track surgery-an update on physiological care principles to enhance recovery. Langenbecks Arch Surg. 2011;396(5):585–90. (Epub 2011 Apr 6).CrossRefPubMed Kehlet H. Fast-track surgery-an update on physiological care principles to enhance recovery. Langenbecks Arch Surg. 2011;396(5):585–90. (Epub 2011 Apr 6).CrossRefPubMed
Metadaten
Titel
Pain perception and short-term outcomes in totally laparoscopic colonic surgery with two different fast track programs
verfasst von
G. Mari, MD
P. De Martini, MD
D. Maggioni, MSI
A. Costanzi, MD
G. Ferrari, MD
S. De Carli, MD
R. Pugliese, MSI
Publikationsdatum
01.10.2015
Verlag
Springer Vienna
Erschienen in
European Surgery / Ausgabe 5/2015
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-015-0343-7

Weitere Artikel der Ausgabe 5/2015

European Surgery 5/2015 Zur Ausgabe