Show Me the Evidence: Epidurals, PVBs, TAP Blocks Christopher L. Wu, MD Professor of Anesthesiology The Johns Hopkins Hospital
|
|
- Veronica Bernice Wade
- 5 years ago
- Views:
Transcription
1 Show Me the Evidence: Epidurals, PVBs, TAP Blocks Christopher L. Wu, MD Professor of Anesthesiology The Johns Hopkins Hospital Overview Review overall (ERAS and non-eras) data for EA, PVB, TAP Examine ERAS-specific data (if available) Focus on systematic reviews/metaanalysis and RCTs Looking for comparisons of block vs no block 1
2 Literature Search Not a formal literature search (through an informationalist) December 2015 Pubmed; English language Textwords: [specific block] + metaanalysis /ERAS Epidural: Overall Data Most recent meta 125 trials (9044 patients, 4525 EA) Death with EA (3.1% vs. 4.9%; OR=0.60; 95%CI, ) EA significantly risk of A Fib, SVT, DVT, respiratory depression, pneumonia, ileus, PONV, GI recovery EA significantly risk of arterial hypotension, pruritus, urinary retention, and motor blockade Technical failures 6.1% of patients Ann Surg 2014;259:
3 Ann Surg 2014;259: Ann Surg 2014;259:
4 Epidural: ERAS Data Epidural and enhanced recovery / fast track (limit to RCT) = at least 5 RCTs comparing EA vs. no EA (within an ERAS pathway) EA typically imbedded in an ERAS pathway and was not examined separately (ERAS vs. no ERAS) Not a clear benefit for EA in these RCTs 2 meta-analyses on EA in laparoscopic procedures Not technically ERAS per se JAMA Surg 2014;149: Surg Endosc 2013;27: Epidural: ERAS Data Hip fracture surgery (n=60) 4 days postoperative EA (bupiv+mso 4 ) vs. placebo Well-defined multimodal rehabilitation, 1 gm paracetamol q6h + 25 mg rofecoxib qd during the entire study period EA superior analgesia but no enhanced rehabilitation Elective cardiac surgery (n=654) Fast-track GA+TEA vs. fast-track GA alone All patients received paracetamol 1 gm q6h EA VAS pain up to 48 h (but pain scores low in both groups); no difference in major complications Anesthesiology 2005;102: Anesthesiology 2011;114:
5 Epidural ERAS: Event Free Survival Anesthesiology 2011;114: Epidural: ERAS Data Laparoscopic sigmoidectomy (n=60) GA+EA vs. GA; pts treated according to ERAS principles EA x 48h; ketoprofen 100 mg IV tid; paracetamol 1 gm PO qid EA pain at rest/cough; no difference in return of GI function/los/complication rate Major intestinal resection (n=56) GA+EA vs GA; both groups followed a fast-track pathway EA x 48h;? multimodal analgesia EA no difference in pain, LOS, quality of life, complications Six patients (20.6%) failed epidurals Surg Endosc 2009;23:31-7 Am J Surg 2005;189:
6 Epidural: ERAS Data Elective laparoscopic colorectal resections (n=128) GA+EA vs. GA; enhanced recovery pathway (since 2006) EA x 48 h; paracetamol 1 gm PO qid; metamizole 500 mg qid EA overall complications/vasopressor treatment perioperatively; no difference in LOS, pain scores Epidurals seem to slow down recovery after laparoscopic colorectal resections without adding obvious benefits Ann Surg 2015;261: Epidural ERAS: Vasopressor Use Ann Surg 2015;261:
7 Epidural: ERAS Data Overall benefits of TEA in laparoscopic procedures uncertain Meta-analysis of 7 RCTs (n=378): epidurals vs. alternative analgesic methods No significant difference in complication rate (OR=1.14 [0.49, 2.64], p=0.76) or LOS; EA faster return of GI fxn, pain scores Meta-analysis (6 RCTs): epidural analgesia on laparoscopic colorectal surgery TEA = first bowel motion (p=0.02) and pain scores (p=0.04) but no difference in LOS hospital, OR time, side effects JAMA Surg 2014;149: Surg Endosc 2013;27: Epidural: Summary Overall data suggests EA pain, pulmonary and cardiac morbidity, earlier return of GI function Role/benefits of epidural in ERAS less certain EA pain but limited available data indicates no benefit in LOS/complications 7
8 TAP Block: Overall Data TAP and surgery (limit RCT) 140 citations At least 10 meta-analyses examining TAP blocks TAP vs. no TAP: overall TAP pain/opioid use,?ponv Preoperative better than postoperative TAP Analgesic efficacy of TAP minimized by IT opioids TAP vs. LA wound infiltration Comparable short-term analgesia; TAP block superior long-lasting analgesia Anesth Analg 2014;118: Anesth Analg 2015;121: Colorectal Dis 2102;14,e Int J Clin Exp Med 2014;7: BMC Anesthesiology 2014;14:121 Can J Anaesth 2012;59: J Clin Anesth 2011;23:7-14 Dis Colon Rectum 2014;57: Cochrane Database Syst Rev 2010;12:CD Eur J Obstet Gynecol Reprod Biol 2013;166:1-9 TAP Block: Overall Data De Oliveira Jr et al (2014): 10 RCTs (n=633) TAP Pain 4/24 hrs; opioid use Preoperative (vs postoperative) TAP early pain Association between LA dose and late pain/opioids use Baeriswyl et al (2015): 31 RCTs (n=1611) US guided TAP only TAP Pain 6h and opioid 6/24 hrs; no difference in PONV or prutirus No additional analgesia for SA with long-acting opioid Anesth Analg 2014;118: Anesth Analg 2015;121:
9 De Oliveira Jr et al: Early Pain at Rest Anesth Analg 2014;118: De Oliveira Jr et al: Late Pain at Rest Anesth Analg 2014;118:
10 Baeriswyl et al: Opioid Consumption Anesth Analg 2015;121: TAP Block: ERAS Data TAP and surgery (limit to RCT) = approximately 35 RCTs comparing TAP vs. no TAP No obvious evidence that these RCT were ERAS Review of Methods section gave no indication for an ERAS pathway Several RCTs which included TAP as part of multimodal analgesic regimen (4 CD, 2 GYN, Lap chole) Minority of TAP RCTs incorporated multimodal analgesia Results equivocal 10
11 TAP Block: ERAS Data Elective CD under SA w/ IT MSO 4 0.1mg (n=100) 40 ml of 0.375% ropivacaine or saline; 50 mg PO diclofenac q8hrs + 1 gm PO acetaminophen q6hrs x 48 hrs postoperatively TAP block, when used as part of a multimodal regimen inclusive of intrathecal morphine, does not improve post-cd analgesia Elective CD under SA w/ IT fentanyl 15µg (n=50) 40 ml of 0.5% ropivacaine or saline; rectal diclofenac 100 mg and rectal acetaminophen 1 gm at the end of surgery Acetaminophen 1 gm PO qid + ibuprofen 400 mg PO tid No difference in VAS pain scores; TAP = opioid usage; improved satisfaction with pain relief Reg Anesth Pain Med 2009;34:586-9 Br J Anaesth 2009;103: TAP Block: ERAS Data Elective CD under SA w/ IT fentanyl 15µg (n=50) 1.5 mg/kg ropivacaine 0.75% (max = 150 mg) per side; rectal diclofenac 1 mg/kg (max = 100 mg), rectal acetaminophen 1 gm at the end of surgery Acetaminophen 1 gm PO qid + rectal diclofenac 100 mg q18h TAP VAS pain scores/opioid usage/incidence of sedation CD under SA w/ IT fent 10µg and MSO mg (n=60) TAP: high- (3 mg/kg), low-dose ropivacaine (1.5 mg/kg), saline IV ketorolac 30 mg at skin closure; IV ketorolac 30 mg and acetaminophen 650 mg PO q6h x 24h TAP: no difference in pain except pain w/ high-dose at 6 hrs Anesth Analg 2008;106: Int J Obstet Anesth 2013;22:
12 TAP Block: ERAS Data Abdominal hysterectomy (n=50) 1.5 mg/kg ropivacaine 0.75% (max=150 mg); rectal diclofenac 100 mg, rectal acetaminophen 1 gm before incision Rectal acetaminophen 1 gm q6h; rectal diclofenac 100 mg q16h TAP VAS pain scores/opioid usage/incidence of sedation Laparoscopic hysterectomy (n=197) 40 ml of 0.25% bupivacaine Acetaminophen 1 gm PO qid, ibuprofen 400 mg PO tid x 5d TAP: VAS pain at discharge; no differences pain scores between groups at 24/48/72 h or opioid use Anesth Analg 2008;107: Acta Obstet Gynecol Scand 2014;93: TAP Block: ERAS Data Laparoscopic cholecystectomy (n=80) 50 ml of 0.25% bupivacaine; 1 gm paracetamol q6h and 75 mg diclofenac at 12 hrs post operation TAP: VAS pain at 6 hrs; no difference in opioid use Laparoscopic cholecystectomy (n=80) 20 ml of 0.5% ropivacaine; acetaminophen 1 gm PO q6h, ibuprofen 400 mg PO q6h TAP: opioid use/vas pain with cough; no difference in pain at rest/ponv/sedation J Am Coll Surg 2015;221: Anesth Analg 2012;115:
13 TAP Block: ERAS Data Large bowel resection (n=32) 40 ml of 0.375% levobupivacaine; rectal diclofenac 1 mg/kg (max=100 mg), rectal acetaminophen 1 gm before incision Acetaminophen 1 gm PO q6h, and rectal diclofenac 100 mg q18h TAP VAS pain and opioid use Anesth Analg 2007;104:193-7 TAP Block: Summary Overall TAP block data Some overall analgesic efficacy Preoperative better than postoperative TAP Analgesic efficacy of TAP minimized by IT opioids No TAP block data with ERAS pathway per se When examining TAP in context of multimodal analgesic regimen, data is uncertain 13
14 Paravertebral Block: Overall Data PVB vs. no PVB Inguinal hern. PONV Breast Pain (up to 72 h)/opioid use, QoR/satisfaction Thoracotomy pulmonary complications PVB vs. other neuraxial blocks Inguinal hern. Nausea/urinary retention Thoracotomy comparable pain relief vs. EA, PONV, urinary retention, hypotension PVB vs. other blocks Inguinal hern. Pain vs. ilioinguinal/tap block Anesth Analg 2015;121: Br J Anaesth 2010;105: Pain Physician 2015;18:E J Plast Reconstr Aesthet Surg 2011;64: PLoS One 2014;9:e96233 Br J Anaesth 2006;96: Anesth Analg 2008;107: PVB (vs. no block): Pain at 24 hours 14
15 PVB (vs. no block): PONV J Plast Reconstr Aesthet Surg 2011;64: PVB vs. EA: Pain at 24 hours PLoS One 2014;9:e
16 PVB vs. EA: Hypotension PLoS One 2014;9:e96233 Paravertebral Block: ERAS Data Paravertebral and surgery (limit to RCT) = approximately 26 RCTs comparing PVB vs. no PVB No obvious evidence that these RCT were ERAS Review of Methods section gave no indication for an ERAS pathway Few studies incorporated multimodal analgesia 16
17 Paravertebral Block: ERAS Data Video-assisted thoracoscopic surgery (n=80) 6 PVB (5 ml of 0.5% bupivacaine with % epi) or saline 15 mg IV ketorolac q6h x 24 h PVB Intraoperative fentanyl/iv PCA morphine use; max pain scores at 6 hrs Breast cancer surgery (n=60) Single-injection PVB with bupivacaine 5 mg/ml (1.5 mg/kg) or saline before general anesthesia. Acetaminophen 1 gm PO tid; ibuprofen 10 mg/kg PO tid PVB opioid use/pain at 24 hrs/ponv in PACU/sedation Anesthesiology 2006;104: Anesth Analg 2004;99: PVB Block: Summary Overall PVB block data PVB pain/ponv/pulmonary complications Comparable analgesia to epidural PONV, urinary retention, hypotension Little PVB block data with ERAS pathway per se Few studies incorporating PVB with multimodal Pain/PONV/opoid use 17
18 Final Thoughts Overall analgesic benefits for EA, TAP, PVB Typically pain, opioid consumption and occasionally complications Little available data examining these blocks in context of an ERAS pathway Blocks are considered part of multimodal analgesia Benefits may not be as obvious in the presence of an ERAS pathway 18
ERAS: Enhanced Recovery After Surgery. Christopher L. Wu, M.D. Professor of Anesthesiology The Johns Hopkins University; Baltimore, Maryland
ERAS: Enhanced Recovery After Surgery Christopher L. Wu, M.D. Professor of Anesthesiology The Johns Hopkins University; Baltimore, Maryland Overview History and basic principles of ERAS Review published
More informationCurrent evidence in acute pain management. Jeremy Cashman
Current evidence in acute pain management Jeremy Cashman Optimal analgesia Best possible pain relief Lowest incidence of side effects Optimal analgesia Best possible pain relief Lowest incidence of side
More informationPerioperative Pain Management
Perioperative Pain Management Overview and Update As defined by the Anesthesiologist's Task Force on Acute Pain Management are from the practice guidelines from the American Society of Anesthesiologists
More informationNerve Blocks & Long Acting Analgesia for Plastic Surgeons. Karol A Gutowski, MD, FACS
Nerve Blocks & Long Acting Analgesia for Plastic Surgeons Karol A Gutowski, MD, FACS Disclosures None related to this topic Why is Non-Opioid Analgesia Important Opioid epidemic Less opioid use Less PONV
More informationBalanced Analgesia With NSAIDS and Coxibs. Raymond S. Sinatra MD, Ph.D
Balanced Analgesia With NSAIDS and Coxibs Raymond S. Sinatra MD, Ph.D Prostaglandins and Pain The primary noxious mediator released from damaged tissue is prostaglandin (PG) PG is responsible for nociceptor
More informationFast Track Surgery and Surgical Carepath in Optimising Colorectal Surgery. R Sim Centre for Advanced Laparoscopic Surgery, TTSH
Fast Track Surgery and Surgical Carepath in Optimising Colorectal Surgery R Sim Centre for Advanced Laparoscopic Surgery, TTSH Conventional Surgery Postop care Nasogastric tube Enteral feeds when ileus
More informationIntravenous lidocaine infusions. Dr Ian McConachie FRCA FRCPC
Intravenous lidocaine infusions Dr Ian McConachie FRCA FRCPC Thank the organisers for inviting me. No conflicts or disclosures Lidocaine 1 st amide local anesthetic Synthesized in 1943 by Lofgren in Sweden.
More informationRole and safety of epidural analgesia
Anaesthesia for Liver Resection Surgery The Association of Anaesthetists Seminars 21 Portland Place, London Thursday 15 th December 2005 Role and safety of epidural analgesia Lennart Christiansson MD,
More informationENHANCED RECOVERY PROTOCOLS FOR KNEE REPLACEMENT
ENHANCED RECOVERY PROTOCOLS FOR KNEE REPLACEMENT Jeff Gadsden, MD, FRCPC, FANZCA Associate Professor Duke University Department of Anesthesiology Regional Anesthesia and Acute Pain Medicine DISCLOSURES
More informationSenior Visceral Surgery Fast-Track in Colorectal Surgery The anesthetist s point of view
Senior Visceral Surgery Fast-Track in Colorectal Surgery The anesthetist s point of view 1st Geneva International SCIENTIFIC DAY February 3 rd 2010 E. Schiffer Dept APSI, HUG 1 Fast-Track in colorectal
More informationCAESAREAN SECTION Brian Fredman
CHAPTER 3 GYNAECOLOGICAL SURGERY CAESAREAN SECTION Brian Fredman Review of evidence: surgical site infusion Of the seven studies on surgical site local anaesthetic infusion after Caesarean section performed
More informationContinuous Wound Infusion and Postoperative Pain Current status?
Continuous Wound Infusion and Postoperative Pain Current status? Pr Patricia Lavand homme Department of Anesthesiology St Luc Hospital University Catholic of Louvain Medical School Brussels, Belgium Severe
More informationTAP blocks vs wound infiltration in laparoscopic colectomies Results of a Randomised Controlled Clinical Trial
TAP blocks vs wound infiltration in laparoscopic colectomies Results of a Randomised Controlled Clinical Trial Kim Gorissen Frederic Ris Martijn Gosselink Ian Lindsey Dept of Colorectal Surgery Dept of
More informationObjectives 9/7/2012. Optimizing Analgesia to Enhance the Recovery After Surgery CME FACULTY DISCLOSURE
Optimizing Analgesia to Enhance the Recovery After Surgery Francesco Carli, M.D.. McGill University, Montreal, QC, Canada. ASPMN, Baltimore, 2012 CME FACULTY DISCLOSURE Francesco Carli has no affiliation
More informationLaparoscopic Colorectal Surgery
Laparoscopic Colorectal Surgery 20 th November 2015 Dr Adam Cichowitz General Surgeon Laparoscopic Colorectal Surgery Introduced in early 1990s Uptake slow Steep learning curve Requirement for equipment
More informationMr David A McDonald Service Improvement Manager Whole System patient Flow Improvement Programme Scottish Government
Mr David A McDonald Service Improvement Manager Whole System patient Flow Improvement Programme Scottish Government Introduction Brief update Two main topics Use of Gabapentin Local Infiltration Analgesia
More informationPost Caesarean Analgesia An Update. Kim Ekelund MD, PhD, associate professor Rigshospitalet Copenhagen, Denmark
Post Caesarean Analgesia An Update Kim Ekelund MD, PhD, associate professor Rigshospitalet Copenhagen, Denmark Post caesarean analgesia No Conflicts of Interests Neuraxial opioids Multimodal therapy Plan
More informationRECENT ADVANCES IN ANALGESIA
4th ERAS UK Conference RECENT ADVANCES IN ANALGESIA Dr William J Fawcett Royal Surrey County Hospital, Guildford University of Surrey, Guildford November 14th 2014 Conflict of interests Paid honoraria
More informationProfessor Narinder Rawal, MD, PhD, FRCA (Hon), EDRA Department of Anaesthesiology and Intensive Care University Hospital Örebro, Sweden
Professor Narinder Rawal, MD, PhD, FRCA (Hon), EDRA Department of Anaesthesiology and Intensive Care University Hospital Örebro, Sweden Infiltrative techniques in perioperative pain lecture outline Why
More informationPost-operative Analgesia for Caesarean Section
Post-operative Analgesia for Caesarean Section Introduction Good quality analgesia after any surgery leads to earlier mobilisation, fewer pulmonary and cardiac complications, a reduced risk of DVT and
More informationANICOLAU.RO. Enhanced Recovery after Colorectal Surgery. Irina Grecu, Alexandru E. Nicolau, Olle Ljungqvist*
Enhanced Recovery after Colorectal Surgery Irina Grecu, Alexandru E. Nicolau, Olle Ljungqvist* Clinical Emergency Hospital of Bucharest, Romania *Karolinska Institute, Stockholm, Sweden ERAS - Enhanced
More informationWhat s New in Post-Cesarean Analgesia?
Anesthesia & Obstetrics What s New in Post-Cesarean Analgesia? October 23rd, 2013 2013 UCSF What Does The Evidence Tell Us? Mark Rollins, MD, PhD UC SF Post-Delivery Pain (Mean pain scores for first 24
More informationSatisfactory Analgesia Minimal Emesis in Day Surgeries. (SAME-Day study) A Randomized Control Trial Comparing Morphine and Hydromorphone
Satisfactory Analgesia Minimal Emesis in Day Surgeries (SAME-Day study) A Randomized Control Trial Comparing Morphine and Hydromorphone HARSHA SHANTHANNA ASSISTANT PROFESSOR ANESTHESIOLOGY MCMASTER UNIVERSITY
More informationAnalgesia after c delivery - wound infusions, tap blocks and intrathecal opioids; what more can we offer our patients?
Analgesia after c delivery - wound infusions, tap blocks and intrathecal opioids; what more can we offer our patients? Ashraf S Habib, MBBCh, MSc, MHSc, FRCA Associate Professor of Anesthesiology Interim
More informationEnhanced Recovery after Surgery - A Colorectal Perspective. R Sim Centre for Advanced Laparoscopic Surgery, TTSH
Enhanced Recovery after Surgery - A Colorectal Perspective R Sim Centre for Advanced Laparoscopic Surgery, TTSH Conventional Surgery Postop care Nasogastric tube Enteral feeds when ileus resolves Opioid
More informationEfficacy of postoperative epidural analgesia Block B M, Liu S S, Rowlingson A J, Cowan A R, Cowan J A, Wu C L
Efficacy of postoperative epidural analgesia Block B M, Liu S S, Rowlingson A J, Cowan A R, Cowan J A, Wu C L CRD summary This review evaluated the efficacy of post-operative epidural analgesia. The authors
More informationWelcome Charles Kennedy
Welcome Charles Kennedy Comoderators Girish P. Joshi, MBBS, MD, FFARCI Professor of Anesthesiology and Pain Management University of Texas Southwestern Medical Center Dallas, Texas David E. Beck, MD, FACS
More informationGabapentin Does Not Improve Analgesia Outcomes For Total Joint Replacement. Manyat Nantha-Aree, MD
Gabapentin Does Not Improve Analgesia Outcomes For Total Joint Replacement Manyat Nantha-Aree, MD Objective n Preliminary results of MOBILE study in total hip and knee arthroplasty Background n Gabapentin=
More informationManagement of Acute Pain in the Chronic Pain Patient. Eric Cannon, MD Mountain West Anesthesia December 1, 2017
Management of Acute Pain in the Chronic Pain Patient Eric Cannon, MD Mountain West Anesthesia December 1, 2017 Objectives 1. Describe the unique challenges of managing acute pain episodes in patients being
More informationThe intensity of preoperative pain is directly correlated with the amount of morphine needed for postoperative analgesia
The intensity of preoperative pain is directly correlated with the amount of morphine needed for postoperative analgesia This study has been published: The intensity of preoperative pain is directly correlated
More informationThe effect of laxative use in length of hospital stay and complication rate in patients undergoing elective colorectal surgery within an ERAS setting.
The effect of laxative use in length of hospital stay and complication rate in patients undergoing elective colorectal surgery within an ERAS setting. { Thalia Petropoulou, Clinical Fellow Paul Hainsworth,Colorectal
More informationRegional anaesthesia in paediatric day case surgery. PA Lönnqvist Karolinska Institutet Karolinska University Hospital Stockholm, Sweden
Regional anaesthesia in paediatric day case surgery PA Lönnqvist Karolinska Institutet Karolinska University Hospital Stockholm, Sweden Ambulatory surgery in children Out-patient surgery in children did
More informationGUIDELINEs ON PAIN MANAGEMENT IN UROLOGY
GUIDELINEs ON PAIN MANAGEMENT IN UROLOGY (Text update March 2009) P. ader (chair), D. Echtle, V. Fonteyne, G. De Meerleer, E.G. Papaioannou, J.H. Vranken General principles of cancer pain management The
More informationLabor Epidural: Local Anesthetics and Beyond
Goals: Labor Epidural: Local Anesthetics and Beyond Pedram Aleshi MD The Changing Practice of Anesthesia September 2012 Review Concept of MLAC Local anesthetic efficacy Local anesthetic sparing effects:
More informationScreening - inclusion criteria
PAIN OUT Community research EU ROP EAN COMMISSION A Date of data collection: B Time of data collection: C Ward where data is collected: 2 0 1 Y M M D D H H M M D Research assistant Code: Room number: Screening
More informationFluid Balance in an Enhanced Recovery Pathway. Edwin Itenberg, DO, FACS, FASCRS St. Joseph Mercy Oakland MSQC/ASPIRE Meeting April 28, 2017
Fluid Balance in an Enhanced Recovery Pathway Edwin Itenberg, DO, FACS, FASCRS St. Joseph Mercy Oakland MSQC/ASPIRE Meeting April 28, 2017 No Disclosures 2 Introduction The optimal intravenous fluid regimen
More informationRegional Anaesthesia for Children
Regional Anaesthesia for Children Indispensable! but also safe? PD Dr. med. Jacqueline Mauch Outline Significance of regional anaesthesia in paediatric surgery Risks and complications of regional anaesthesia
More informationHow to manage severe postoperative pain? Pr Patricia Lavand homme Anesthesiology Dpt & Acute Pain Service Brussels, Belgium
How to manage severe postoperative pain? Pr Patricia Lavand homme Anesthesiology Dpt & Acute Pain Service Brussels, Belgium No conflict of interest to declare. Does severe acute postoperative pain still
More informationAnalgesia for ERAS programs. Dr Igor Lemech VMO Anaesthetist Wagga Wagga Base Hospital
Analgesia for ERAS programs Dr Igor Lemech VMO Anaesthetist Wagga Wagga Base Hospital Disclosure I have received honoraria from Mundipharma and MSD The new Wagga Wagga Rural Referral Centre Scope Analgesic
More informationINGUINAL HERNIOTOMY Updated by Narinder Rawal
Sistla SC, Sibal AK, Ravishankar M. Intermittent wound perfusion for postoperative pain relief following upper abdominal surgery: a surgeon s perspective. Pain Practice 2009;9:65 70. Sorbello M, Paratore
More informationUpdate Update on Anaesthesia for c-section Dr Kerry Litchfield Consultant Anaesthetist Princess Royal Maternity Glasgow, Scotland
Update Update on Anaesthesia for c-section Dr Kerry Litchfield Consultant Anaesthetist Princess Royal Maternity Glasgow, Scotland Caesarean section is the most common surgical procedure in the world 1
More informationLearning Objectives. Perioperative goals. Acute Pain in the Chronic Pain Patient for Ambulatory Surgery 9/8/16
Acute Pain in the Chronic Pain Patient for Ambulatory Surgery Danielle Ludwin, MD Associate Professor of Anesthesiology Division of Regional and Orthopedic Anesthesia Columbia University Medical Center
More informationSEEING KETAMINE IN A NEW LIGHT
SEEING KETAMINE IN A NEW LIGHT BobbieJean Sweitzer, M.D., FACP Professor of Anesthesiology Director of Perioperative Medicine Northwestern University Bobbie.Sweitzer@northwestern.edu LEARNING OBJECTIVES
More informationJan G. Jakobsson, Liselott Wickerts, Sune Forsberg, Gustaf Ledin
REVIEW Transversus abdominal plane (TAP) block for postoperative pain management: a review [version 1; referees: 2 approved] Jan G. Jakobsson, Liselott Wickerts, Sune Forsberg, Gustaf Ledin Department
More informationInternational Journal of Pain & Relief. Department of Anesthesiology, the University Of Arkansas for Medical Sciences, Little Rock, AR, USA
International Journal of Pain & Relief Research Article A Retrospective Analysis of the Effects of Transversus Abdominis Plane Blocks With and Without Analgesic Ketamine in Multimodal Analgesia Regimens
More informationAnaesthesia and Pain Management for Endo Exo Femoral Prosthesis (EEFP) Bridging the Gap from Surgery to Rehabilitation
Anaesthesia and Pain Management for Endo Exo Femoral Prosthesis (EEFP) Bridging the Gap from Surgery to Rehabilitation Dr Ajay Kumar Senior Lecturer Macquarie and Melbourne University Introduction Amputee
More informationEvidenzbasiertes, perioperatives Analgesie- Konzept in der Fast Track Chirurgie. Christoph Konrad Luzern
Evidenzbasiertes, perioperatives Analgesie- Konzept in der Fast Track Chirurgie Christoph Konrad Luzern Prävalenz Prävalenz 40.0 Hüft TEP Leistenhernie Knie TEP Thorakotomie 30.0 20.0 Br J Anaesth. 2010
More informationWITH ISOBARIC BUPIVACAINE (5 MG/ML)
, 49, 2013, 3 63 (5 MG/ML) (5 MG/ML).,.,.,..,..,, SPINAL ANESTHESIA: COMPARISON OF ISOBARIC ROPIVACAINE (5 MG/ML) WITH ISOBARIC BUPIVACAINE (5 MG/ML) D. Tzoneva, Vl. Miladinov, Al. Todorov, M. P. Atanasova,
More informationScreening - inclusion criteria
A Date of data collection: B Time of data collection: C Ward where data is collected: 2 0 1 Y M M D D H H M M D Research assistant Code: Patient code (local): Room number: Screening - inclusion criteria
More informationNEW KIDS ON THE BLOCK: THE NEW ERA OF REGIONAL ANESTHESIA PLANE BLOCKS
2017 CSA Fall Anesthesia Conference NEW KIDS ON THE BLOCK: THE NEW ERA OF REGIONAL ANESTHESIA PLANE BLOCKS Michael Barrington, MB BS, FANZCA, PhD Senior Staff Anaesthetist, St Vincent s Hospital, Melbourne.
More informationOperational Efficiency in Colon Surgery Enhanced Recovery Pathways: 23 hour laparoscopic colectomy
Enhanced Recovery Pathways: 23 hour laparoscopic colectomy Conor P. Delaney MD MCh PhD Chairman, Digestive Disease Institute Professor of Surgery, Cleveland, Ohio Disclosure Slide Conor Delaney MD PhD
More informationOral Oxycodone for Acute Postoperative Pain: A Review of Clinical Trials. Pain Physician Opioid Special Issue 2017; 20:SE33-SE52
Pain Physician 2017; 20:SE33-SE52 ISSN 2150-1149 Narrative Review Oral Oxycodone for Acute Postoperative Pain: A Review of Clinical Trials Chi Wai Cheung, MD 1, Stanley Sau Ching Wong, MBBS 1, Qiu Qiu,
More informationAssistant Professor, Anaesthesia Department, Govt. General Hospital / Guntur Medical College, Guntur, Andhra Pradesh, India.
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 15, Issue 8 Ver. I (August. 2016), PP 87-91 www.iosrjournals.org A Comparative Study of 0.25% Ropivacaine
More informationEpidural technique for postoperative pain - gold standard no more?
- gold standard no more? Narinder Rawal Epidural analgesia is a well-recognised technique for postoperative pain since decades. Several metaanalyses have shown that the technique has several additional
More informationANAESTHESIA FOR LIVER SURGERY
Seminars at 21 Portland Place ANAESTHESIA FOR LIVER SURGERY This seminar is organised in conjunction with the Liver Intensive Care Group of Europe Wednesday 18 th October 2006 Seminars at 21 Portland Place
More informationPre-op Interventions to Mitigate Post-op Acute and Chronic Pain
Pre-op Interventions to Mitigate Post-op Acute and Chronic Pain H A R S H A S H A N T H A N N A. M D, M S C A S S O C I A T E P R O F E S S O R D E P A R T M E N T O F A N E S T H E S I A C H R O N I C
More informationNutritional Support in the Perioperative Period
Nutritional Support in the Perioperative Period Topic 17 Module 17.6 Facilitating Oral or Enteral Nutrition in the Postoperative Period Mattias Soop Learning Objectives To review the causes of postoperative
More informationGastrointestinal and urinary complications in the postoperative period
The 13 th Annual Perioperative Medicine Summit Fort Lauderdale, Florida Gastrointestinal and urinary complications in the postoperative period Dan Hunt, MD Professor of Medicine Director, Division of Hospital
More informationCombined Subfascial and Subcutaneous Bupivacaine Instillation for Inguinal Hernia Wounds
Original Article Combined Subfascial and Subcutaneous Bupivacaine Instillation for Inguinal Hernia Wounds Khaled Mohammed El-Radaideh, Mohammed Ahmed Al-Ghazo 1 and Kamal Eddin Bani-Hani, 2 Departments
More informationRichard Smiley, MD, PhD Virginia Apgar MD Professor of Anesthesiology Chief, Obstetric Anesthesia Columbia University Medical Center New York, NY,
Richard Smiley, MD, PhD Virginia Apgar MD Professor of Anesthesiology Chief, Obstetric Anesthesia Columbia University Medical Center New York, NY, USA Disclosures Off label use: Fentanyl, Sufentanil IT
More informationIs There an Ideal Regimen for CPNB?
Is There an Ideal Regimen for CPNB? Dr Eric Albrecht, MD, DESA Department of Anesthesiology, CHUV 2nd SARA Annual Symposium June 2013 Manuel pratique d ALR échoguidé, Elsevier Masson, Paris, 2013 Albrecht
More informationAnesthesia for Total Hip and Knee Arthroplasty
Anesthesia for Total Hip and Knee Arthroplasty Typical approach Describe anesthesia technique Rather Describe issues with THA and TKA How anesthesia can modify Issues Total Hip Total Knee Blood Loss ++
More informationFiegel, Matthew, MD Regional Anesthesia and Pain Medicine Update 2013
Regional Anesthesia and Pain Medicine Update: 2013 CRASH I have no disclosures Disclosures Matthew J. Fiegel, M.D. Associate Professor of Anesthesiology University of Colorado Director, Acute Pain Service
More informationWhat s new in obstetric anesthesia?
SAOA 2013 - SPRING MEETING BERN What s new in obstetric anesthesia? PD Dr. Med Georges Savoldelli Médecin Adjoint Unité d anesthésiologie gynéco-obstétricale Service d Anesthésiologie, HUG An objectively
More informationDoes Anesthesia influence Cancer recurrence? Dr Ian McConachie FRCA FRCPC London, ON, Canada
Does Anesthesia influence Cancer recurrence? Dr Ian McConachie FRCA FRCPC London, ON, Canada Why did my cancer come back? Inadequate resection Micro metastases Lymph spread Tumour biology Immune system
More informationERAS. Presented by Timothy L. Beard MD, FACS, CPI Bend Memorial Clinic
ERAS Presented by Timothy L. Beard MD, FACS, CPI Bend Memorial Clinic Outline Definition Justification Ileus Pain Outline Specifics Data BMC Data Worldwide Data Implementation What is ERAS? AKA Fast-track
More informationAcute Post-Surgical Pain Management: A Critical Appraisal of Current Practice
Acute Post-Surgical Pain Management: A Critical Appraisal of Current Practice James P. Rathmell, M.D., Christopher L. Wu, M.D., Raymond S. Sinatra, M.D., Ph.D., Jane C. Ballantyne, M.D., F.R.C.P., Brian
More informationSufentanil Sublingual Tablet System 15mcg vs IV PCA Morphine: A Comparative Analysis of Patient Satisfaction and Drug Utilization by Surgery Type
Sufentanil Sublingual Tablet System 15mcg vs IV PCA Morphine: A Comparative Analysis of Patient Satisfaction and Drug Utilization by Surgery Type 2016 European Society of Regional Anesthesia Congress Maastricht,
More informationIs Local Infiltration Analgesia (LIA) a Safe and Effective Method for Post-Operative Pain Management After a Unilateral Total Knee Arthroplasty (TKA)?
Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 2013 Is Local Infiltration Analgesia (LIA)
More informationFast Track Surgery at the University Teaching Hospital of Kigali: A Randomized Controlled Trial Study in Abdominal Surgery
12 Fast Track Surgery at the University Teaching Hospital of Kigali: A Randomized Controlled Trial Study in Abdominal Surgery L Ndayizeye, A K Kiswezi University Teaching Hospital of Butare, Rwanda. Correspondence
More informationPre-medication with controlled-release oxycodone in the management of postoperative pain after ambulatory laparoscopic gynaecological surgery
Page 1 of 5 Anaesthetics & Critical Care Pre-medication with controlled-release oxycodone in the management of postoperative pain after ambulatory laparoscopic gynaecological surgery B Lim 1, SY Thong
More informationPerceptions of the application of fast-track surgical principles by general surgeons
The Royal College of Surgeons of England AUDIT doi 10.1308/003588406X94940 Perceptions of the application of fast-track surgical principles by general surgeons CATHERINE JANE WALTER, ADRIAN SMITH, PIERRE
More informationPost-caesarean analgesia. Genevieve Goulding Royal Brisbane & Women's Hospital 1
Post-caesarean analgesia Genevieve Goulding Royal Brisbane & Women's Hospital 1 Contemporary challenges & barriers to providing optimal post-caesarean analgesia Genevieve Goulding Royal Brisbane & Women's
More informationLOCAL ANAESTHESIA IN FIRST TRIMESTER SURGICAL ABORTION. Regina-Maria Renner MD MPH
LOCAL ANAESTHESIA IN FIRST TRIMESTER SURGICAL ABORTION Regina-Maria Renner MD MPH FIAPAC October 20, 2012 Disclosures none Objectives Provide an introduction to pain pathways Provide background regarding
More informationFast-Track Colonic Surgery: Status and Perspectives
Fast-Track Colonic Surgery: Status and Perspectives Henrik Kehlet H. Kehlet ( ) Section for Surgical Pathophysiology, Rigshospitalet, Section 4074, Blegdamsvej 9, 2100 Copenhagen, Denmark e-mail: henrik.kehlet@rh.dk
More informationEffective pain management begins with OFIRMEV (acetaminophen) injection FIRST Proven efficacy with rapid reduction in pain 1
Effective pain management begins with OFIRMEV (acetaminophen) injection FIRST Proven efficacy with rapid reduction in pain 1 Fast onset of pain relief with 7% reduction in visual analog scale (VAS) scores
More informationReview Article Epidural Anesthesia-Analgesia and Patient Outcomes: A Perspective
Advances in Anesthesiology, Article ID 948164, 5 pages http://dx.doi.org/10.1155/2014/948164 Review Article Epidural Anesthesia-Analgesia and Patient Outcomes: A Perspective Christopher L. Wu and Jamie
More informationRashmi Jain 1, Pushpalata Gupta 2, Vinita Jain 3* Original Research Article. Abstract
Original Research Article A comparison of ropivacaine with fentanyl to bupivacaine with fentanyl for postoperative patient controlled epidural analgesia in patients undergone lower abdominal cancer surgery
More informationMETA-ANALYSIS OF INTRATHECAL MORPHINE FOR LUMBAR SPINE SURGERY
META-ANALYSIS OF INTRATHECAL MORPHINE FOR LUMBAR SPINE SURGERY RESIDENT RESEARCH EXCHANGE DAY MAY 30 TH, 2014 SUPERVISOR: DR. JAMES PAUL SUSAN JO PGY4 SUZANNE LAMBERT PGY4 ADA HINDLE PGY4 INTRODUCTION
More informationI ve Got You Under My Skin: A Comparison of IV and s/c PCA. Nick Williamson Clinical Nurse Specialist
I ve Got You Under My Skin: A Comparison of IV and s/c PCA Nick Williamson Clinical Nurse Specialist How did PCA get under my skin? Started in 2009 when I started working at KCH Subcut PCA!!! PCA refers
More informationMD (Anaesthesiology) Title (Plan of Thesis) (Session )
S.No. 1. Comparative Assessment of Sequential organ failure Assessment (SOFA) score and Multiple Organ Dysfunction Score (Mode) in Outcome Prediction among ICU Patients. 2. Comparison of Backpain after
More informationNon-Narcotic Pain Management Strategies in Post-Operative Patients
Non-Narcotic Pain Management Strategies in Post-Operative Patients Danielle Tompkins, PharmD University of Illinois at Chicago, College of Pharmacy PGY2 Critical Care Pharmacy Resident 1 Conflicts of Interest
More informationPresentation objectives. Overcoming Acute Pain Management Hurdles in the Tertiary Setting The High Risk Patient
Overcoming Acute Pain Management Hurdles in the Tertiary Setting The High Risk Patient Ewan McNicol PharmD, MS Presentation objectives Outline principles for management of acute pain, with focus on perioperative
More informationPattern of use of analgesics in post-operative pain management in adults undergoing laparotomy surgery: a prospective observational study
International Surgery Journal Toro MM et al. Int Surg J. 2018 Feb;5(2):662-667 http://www.ijsurgery.com pissn 2349-3305 eissn 2349-2902 Original Research Article DOI: http://dx.doi.org/10.18203/2349-2902.isj20180372
More informationPerioperative Pregabalin & Ketamine as Multimodal Pain Management Strategies
A presentation for HealthTrust members May 31, 2018 Perioperative Pregabalin & Ketamine as Multimodal Pain Management Strategies ELIZABETH A. BADGLEY, PHARMD, BCPS GENERAL MEDICINE & SURGERY CLINICAL SPECIALIST
More informationBeta Blockers for ENT Surgery
Beta Blockers for ENT Surgery Dr. Giuliano Michelagnoli U.O. Anestesia e Rianimazione Nuovo Ospedale di Prato Perioperative Beta-Blockade 1. Reduction of perioperative cardiovascular risk 2. Multimodal
More informationAdvancement in the use of multimodal analgesia for acute postoperative pain
Advancement in the use of multimodal analgesia for acute postoperative pain Ratan K. Banik, M.D., Ph.D. Assistant Professor Department of Anesthesiology University of Minnesota, Minneapolis, USA 4 October
More informationESPEN Congress Vienna Nutrition after discharge from hospital: The surgeon s responsability. O. Ljungqvist (Sweden)
ESPEN Congress Vienna 2009 Nutrition after discharge from hospital: The surgeon s responsability O. Ljungqvist (Sweden) Nutrition after discharge from hospital: The surgeon s responsability Olle Ljungqvist
More informationIf you reduce variability in volume administration, HOW. you can reduce post-surgical complications, LOS and associated costs 1-4
A large body of clinical evidence* demonstrates If you reduce variability in volume administration, you can reduce post-surgical complications, LOS and associated costs 1-4 Complications Too Dry Too Wet
More informationR Sim, D Cheong, KS Wong, B Lee, QY Liew Tan Tock Seng Hospital Singapore
Prospective randomized, double-blind, placebo-controlled study of pre- and postoperative administration of a COX-2- specific inhibitor as opioid-sparing analgesia in major colorectal resections R Sim,
More informationin the treatment of post-thoracotomy pain
Role of thoracic epidural anesthesia/analgesia in the treatment of post-thoracotomy pain 26th International Winter Symposium Update in Cardiothoracic Anesthesia January 7th - 8th, 2011, Leuven, Belgium
More informationANICOLAU.RO. What is ERAS? Enhanced Recovery After Surgery. A.E.Nicolau*,Irina Grecu** Spitalul Clinic de Urgenta
Spitalul Clinic de Urgenta ANICOLAU.RO What is ERAS? Enhanced Recovery After Surgery A.E.Nicolau*,Irina Grecu** *Clinica de Chirurgie **Clinica de Anestezie Terapie Intensiva ERAS = Fast-track surgery
More informationAnesthetic Techniques for Rapid Recovery in Total Knee Arthroplasty
Anesthetic Techniques for Rapid Recovery in Total Knee Arthroplasty Scott T. Ball, MD Chief, Adult Joint Reconstruction Department of Orthopaedic Surgery University of California, San Diego Disclosures
More informationIntraperitoneal and Intravenous Routes for Pain Relief in Laparoscopic Cholecystectomy
SCIENTIFIC PAPER Intraperitoneal and Intravenous Routes for Pain Relief in Laparoscopic Cholecystectomy Samar I. Jabbour-Khoury, MD, Aliya S. Dabbous, MD, Frederic J. Gerges, MD, Mireille S. Azar, MD,
More informationADE and Harm Collaborative: Reducing ADEs and harm associated with opioids - Safer post-operative pain management. March 21, 2013
ADE and Harm Collaborative: Reducing ADEs and harm associated with opioids - Safer post-operative pain management March 21, 2013 Agenda, March 21, 2013 Welcome Collaborative education overview Post-operative
More informationMultimodal perioperative pain management protocols
Multimodal perioperative pain management protocols Nader M. Hebela, MD كليفالند كلينك أبوظبي Dhabi Cleveland Clinic Abu معهد األعصاب Institute Neurological slide count: 30 January 2016 title slide explained
More informationEvaluation of the Effect of Magnesium Sulphate as Adjunct to Epidural Bupivacaine: An Institutional Based Study
Original article: Evaluation of the Effect of Magnesium Sulphate as Adjunct to Epidural Bupivacaine: An Institutional Based Study RajulSubhash Karmakar 1, ShishirRamachandra Sonkusale 1* 1Associate Professor,
More informationSingle Dose Preemptive Thoracic Paravertebral Block For Postoperative Pain Relief After Cholecystectomy
10 Single Dose Preemptive Thoracic Paravertebral Block For Postoperative Pain Relief After Cholecystectomy Tarek Atef Tawfic *, MD; Mohamed Medhat Khalil *, MD *Lecturer of anaesthesia, faculty of medicine,
More informationJoshi GP,* Bonnet F, Shah R, Wilkinson RC, Camu F, Fischer B, Neugebauer. EAM, Rawal N, Schug SA, Simanski C, Kehlet H. A systematic review of
Joshi GP,* Bonnet F, Shah R, Wilkinson RC, Camu F, Fischer B, Neugebauer EAM, Rawal N, Schug SA, Simanski C, Kehlet H. A systematic review of randomized trials evaluating regional techniques for post-thoracotomy
More information