OPIOID SPARING STRATEGIES FOR OBSTETRIC SURGERY: BRINGING ERAS INTO THE CESAREAN SECTION SUITE Gregory Collins, DNP, CRNA
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1 OPIOID SPARING STRATEGIES FOR OBSTETRIC SURGERY: BRINGING ERAS INTO THE CESAREAN SECTION SUITE Gregory Collins, DNP, CRNA
2 FINANCIAL DISCLOSURES: NONE OFF-LABEL DRUG USAGE: ONDANSETRON DEXAMETHASONE
3
4 REVIEW IDENTIFY PROPOSE Review the origins of ERAS and the history of ERAS strategies in OB surgery. Identify strategies shown to reduce opioid consumption after CS. Propose means of evaluation and methods for implementing ERAS strategies.
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8 2017
9 CESAREAN SECTION POST-OP COMPLICATIONS MATERNAL EXPERIENCE PAIN MANAGEMENT
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13 CESAREAN SECTION MATERNAL EXPERIENCE PAIN MANAGEMENT POST-OP COMPLICATIONS
14
15 PREOPERATION INTRAOPERATION POSTOPERATION
16 PREOPERATION ALLOW LIGHT MEAL UP TO 6 HOURS BEFORE SURGERY
17 PREOPERATION ALLOW LIGHT MEAL UP TO 6 HOURS BEFORE SURGERY ENCOURAGE CARB-RICH CL UP TO 2 HOURS BEFORE SURGERY
18 PREOPERATION ALLOW LIGHT MEAL UP TO 6 HOURS BEFORE SURGERY ENCOURAGE CARB-RICH CL UP TO 2 HOURS BEFORE SURGERY INITIATE PHARMACOLOGICAL ASPIRATION PROPHYLAXIS
19 PREOPERATION ALLOW LIGHT MEAL UP TO 6 HOURS BEFORE SURGERY ENCOURAGE CARB-RICH CL UP TO 2 HOURS BEFORE SURGERY INITIATE PHARMACOLOGICAL ASPIRATION PROPHYLAXIS PREGABALIN 100 mg PO 1 HOUR BEFORE SURGERY
20 INTRAOPERATION ACETAMINOPHEN 1000 mg IV BEFORE INCISION
21 INTRAOPERATION ACETAMINOPHEN 1000 mg IV BEFORE INCISION ONDANSETRON 4-8 mg IV JUST PRIOR TO SAB PLACEMENT
22 INTRAOPERATION ACETAMINOPHEN 1000 mg IV BEFORE INCISION ONDANSETRON 4-8 mg IV JUST PRIOR TO SAB PLACEMENT PF MORPHINE 100 mcg INTRATHECAL WITH SAB
23 INTRAOPERATION ACTIVE, FORCED-AIR PATIENT WARMING
24 INTRAOPERATION ACTIVE, FORCED-AIR PATIENT WARMING DEXAMETHASONE 8 mg IV AFTER CORD CLAMP
25 INTRAOPERATION ACTIVE, FORCED-AIR PATIENT WARMING DEXAMETHASONE 8 mg IV AFTER CORD CLAMP CONSIDER TRANSVERSUS ABDOMINUS PLANE BLOCK
26 INTRAOPERATION
27 INTRAOPERATION
28 INTRAOPERATION
29 INTRAOPERATION
30 Reprinted from Block Buddy application.
31 Reprinted from Block Buddy application.
32 Reprinted from Block Buddy application.
33 SQ EOM IOM TAM VENTRAL DORSAL VENTRAL DORSAL
34 VENTRAL DORSAL
35 VENTRAL DORSAL
36 VENTRAL DORSAL VENTRAL DORSAL
37 INTRAOPERATION
38 POSTOPERATION ENCOURAGE EARLY ORAL INTAKE
39 POSTOPERATION ENCOURAGE EARLY ORAL INTAKE ENCOURAGE EARLY REMOVAL OF URINARY CATHETER
40 POSTOPERATION ENCOURAGE EARLY ORAL INTAKE ENCOURAGE EARLY REMOVAL OF URINARY CATHETER ACETAMINOPHEN 1000 mg IV/PO EVERY 6 HOURS
41 POSTOPERATION ENCOURAGE EARLY ORAL INTAKE ENCOURAGE EARLY REMOVAL OF URINARY CATHETER ACETAMINOPHEN 1000 mg IV/PO EVERY 6 HOURS KETOROLAC 30 mg IV EVERY 6 HOURS
42 EDUCATION
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49 Stolen from Tom Baribeault s FaceBook post
50 OUTCOMES?
51
52 QUESTIONS?
53 REFERENCES Hebbard P. Transversalis fascia plane block, a novel ultrasound-guided abdominal wall nerve block. Canadian Journal of Anesthesia/Journal canadien d'anesthésie. 2009;56(8): doi: /s Hutchins J, Renfro L, Orza F, Honl C, Navare S, Berg A. The addition of intrathecal morphine to a transversus abdominis plane block with liposome bupivacaine provides more effective analgesia than transversus abdominis plane block with liposome bupivacaine alone: a retrospective study. Local Reg Anesth. 2019;12:7-13. Tulgar S, Serifsoy T. Transversalis fascia plane block provides effective postoperative analgesia for cesarean section: New indication for known block. J Clin Anesth. 2018;48: doi: /j.jclinane
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