Fast-track Rehabilitation Program Research Articles

Laparoscopic radical nephrectomy with inferior vena cava level I–III thrombectomy: experience of one center and literature review

Objective. Radical nephrectomy with thrombectomy of the inferior vena cava is the preferred treatment for renal cell carcinoma with an tumor thrombosis. We describe our experience and presentreview of the literature evaluating the feasibility and safety of laparoscopic nephrectomy with inferior vena cava thrombectomy.Materials and methods. The study included 37 patients who underwent laparoscopic radical nephrectomy with level I–III thrombectomy for renal cell carcinoma in our institution from 2018 to 2021. We analyzed the clinical, radiographic, intraoperative, pathological and postoperative parameters of the patients. The literature was reviewed by the Medline search engine, PubMed, with a review of publications on laparoscopic radical nephrectomy with inferior vena cava levelI–IIIthrombectomy.Results. The mean operation time was 275 ± 60.1 min, the median blood loss was 450 ± 81.6 ml (≥50 % of the circulating blood volume – 32.4 %). Intraoperative complications were observed during 10 (27.0 %) operations. Postoperative complications developed in 29.7 % of patients and reached gradesIII–IV according to the Clavien–Dindo scale on 13.0 % ill. All patients are activated according to the fast track rehabilitation program. The average hospital stay was 5 days. A literature review identified clinical cases and small series demonstrating the technical feasibility and safety of laparoscopic radical nephrectomy with thrombectomy in selected patients.Conclusion. Laparoscopic radical nephrectomy with thrombectomy is a technically feasible approach in carefully selected patients with level I–III tumor thrombosis. Optimal patient selection, extensive experience in laparoscopy and specialized centers are essential for the safe use of thistechnique.

Conventional versus fast track rehabilitation after total hip replacement: A randomized controlled trial

Background: Total hip replacement (THR) is currently the most successful orthopaedic operation worldwide. This success is, however, dependent on the quality and efficiency of postoperative rehabilitation programs following it. Methods: In a randomized controlled trial (RCT), sixty patients (32 females, 28 males, mean age 68.4 years) undergoing THR for hip arthritis having either a conventional rehabilitation after a normal hospital stay (30 patients) or a fast track rehabilitation program (30 patients) were compared. Results: The mean length of stay in the conventional group was 7.8 (range: 6–11) days compared to 4.5 (range 3–5) days in the fast track group ( p = <0.001). Complications included one dislocation in either group, a case of heart failure and a readmission in the conventional group. As regards functional outcome, patients in the conventional group had a mean Harris Hip Score of 69.3 six weeks and 82 twelve weeks postoperatively in comparison to 79 and 91 in the fast track group respectively. The differences were statistically significant ( p = 0.013 and 0.002 respectively). Conclusion: Fast track rehabilitation after THR allows early patient's mobilization and shorter hospital stay with better functional outcome and without increasing the risk of complications or the readmission rate.

Fast-track rehabilitation after total knee arthroplasty reduces length of hospital stay: A prospective, case-control clinical trial.

Objectives The aim of this study was to compare the impact of fast-track rehabilitation (FTR) and conventional rehabilitation (CR) on early recovery pattern after fast-track surgery for knee arthroplasty and conventional total knee arthroplasty (TKA). Patients and methods This prospective, case-control study included a total of 43 adult patients (10 males, 33 females; mean age 69 years; range, 50 to 82 years) who were clinically stable and admitted for rehabilitation after fast-track surgery for knee arthroplasty or conventional TKA January 2016 and August 2016. The patients were divided into two groups as the FTR and CR treatment groups. The FTR program was designed as a patient-focused care, early mobilization, and standardized postoperative milestones. The CR program was designed by standard postoperative rehabilitation care. Primary outcomes were the length of stay (LOS) in the hospital and knee function. Secondary outcomes were pain and activities of daily living. Results At baseline, both groups were similar in terms of demographic data and primary outcomes. At discharge, intra-group analysis showed significant differences in both groups in all functional outcomes, except for pain, while the inter-group LOS was also significantly different (p<0.001). Conclusion Our study results indicate that LOS can be reduced by FTR, yielding the same results in functional recovery and autonomy as CR.

Clinical benefits of fast-track rehabilitation program for patients with uncomplicated type B acute aortic dissection.

Uncomplicated type B acute aortic dissection (UTBAAD) has traditionally been treated medically. Although patients are treated based on the rehabilitation program established by the Japanese Circulation Society, we sometimes encounter patients with complications related to the long duration of bed rest. We performed novel fast-track rehabilitation for UTBAAD, which consisted of short-duration bed rest and the early initiation of walking under secure blood pressure control. From April 2009 to February 2017, there were 73 consecutive cases of UTBAAD. Conventional medical treatment was administered to 39 patients (group G) during the early period. From August 2013, 34 patients (group F) received our 'fast-track' rehabilitation program, which consisted of the following: oral intake and assuming a sitting position from day 1 after the onset, standing by the bed from day 2, walking in their room from day 4, and discharge from day 16 if all goes smoothly. Group F had a significantly earlier initiation of standing and walking, first defecation, and weaning from oxygen and intravenous antihypertensive agents than group G. The pneumonia complication rate was significantly lower in group F than in group G. The hospitalization duration was markedly shorter and the in-hospital expense lower in group F than in group G. There were no significant differences in the rate of late adverse aortic events within 12months after onset. Our fast-track rehabilitation program for patients with UTBAAD resulted in a better in-hospital clinical course and lower expense than conventional medical treatment without any adverse aortic events.

Outcomes of Enhanced Recovery Protocol versus Traditional Methods after Gastrointestinal Surgical Operations

Abstract Background: Enhanced Recovery after Surgery (ERAS) program is a new set of protocols that is applied to the patient in the peri-operative period to fasten the recovery and decrease the convalescence and thus improving the surgical outcome. It is also named as fast track surgery. Aim of Study: The aim of fast tracking is to attenuate stress response to surgical trauma in order to: Reduce mor-bidity, hospital stay, and costs. Enhance early and safe recovery of the patient after a surgical procedure and to allow patients to resume their normal daily activities as quick as possible. Patients and Methods: In our study we had 50 patients underwent various gastrointestinal surgical operations. The ERAS protocol was implemented on group A with multiple pre, intra and post-operative elements, while group B was managed traditionally. Both groups were closely observed and evaluated during the post-operative period and one month after discharge. Results: There were 6 cases that needed readmission during the first month postoperative , 2 cases in group A (8%) and only 4 cases in group B (16%), but this difference is insignificant. there was no obvious and significant earlier unaided mobilization in group A than group B. There was a clear difference between both groups in length of hospital stay. Patients receiving ERAS protocol stayed definitely shorter period post-operatively. There also was noticed a clear and obvious satisfaction between patients of ERAS group in the form of early mobilization, return to normal activities and pain free. Conclusion: Fast track rehabilitation program plays an important role in the recovery of patients after gastrointestinal operations, which can accelerate the restoration of their gastrointestinal function, decrease their post-operative com-plications, and shorten their hospital stay time.

Enhanced recovery program after colorectal surgery

Abstract Background: Patient undergoing major gastro-intestinal tract surgery are at risk of nutritional depletion due to surgical stress, inadequate nutritional intake and subsequent increase in metabolic rate. The aim of this work is to evaluate the outcome of early oral feeding, balanced analgesia and enforced mobilization, which are integral parts of fast track rehabilitation program of colorectal surgery, versus delayed oral feeding and regular forms of mobilization and pain control in patients undergoing colorectal surgery. Patients and methods: These study was a prospective randomized clinical trial included 40 patient’s undergoing colorectal surgery. Results: Group II showed a high statistically significant operation time than Group I. (p<0.001). Group II showed a high statistically significant NPO while Group I showed a high Oral liquid diet, Full liquid diet and Regular diet (p<0.001). Conclusion: The application of an enhanced recovery program for “elective” colorectal surgery has consistently been shown to decrease postoperative complication, shorten length of hospital stay, facilitate patient recovery, shorten convalescence, and lower healthcare cost. Keywords: Recovery Program, Stomach, Pain control, Colorectal Surgery

Outcomes of an enhanced recovery program after colorectal surgery: a single-center experience

Background Successful care of postoperative patients is dependent on optimal nutritional supports, which enhance wound healing and immune response. Enhanced recovery program (ERP) after surgery employs a multimodal perioperative care pathway with the aim of improving the stress response to surgery and outcomes across a range of participation from the patients, surgeons, anesthesiologists, pain specialists, and nursing staff. Objective The aim was to evaluate the outcome of fast-track rehabilitation program versus delayed oral feeding, regular forms of mobilization, and pain control in patients who underwent colorectal surgery. Design This is a prospective study. Patients and methods The present study included 60 patients who were admitted to the Ain Shams University Hospitals between September 2014 and April 2016. We prospectively compared 30 patients: group A submitted for ERP with 30 patients and group B submitted for conventional rehabilitation program for patient outcomes as regards hospital stay, rehabilitation, hospital readmission, and complications. Results Postoperative vomiting in group A occurred in eight (26.7%) patients, while 17 (56.7%) patients in group B without statistical significance, similar was the case with abdominal distention. The overall compliance in group A was better than in group B. Regarding pain control, only nine patients were in need for additional analgesia, while in group B no one was pain free, so additional analgesia was needed in 11 patients. During the hospital stay, only pulmonary complications and hypokalemia were statistically significant between the two groups (P=0.001 and 0.003, respectively). In group A, the mean total postoperative hospital stay was 4.2±1.56 days while in group B it was 8.4±1.6 days (P=0.0001). Conclusion ERP is safe and tolerable after colorectal surgery with no increase in postoperative morbidity and mortality. ERAS protocols should be implemented as the standard approach for perioperative care in colorectal surgery.

Fast track rehabilitation in perforated duodenal ulcer

To analyze the outcomes of fast track rehabilitation program in patients with perforated duodenal ulcer (PDU). For the period 2013-2016 at the Department of Surgery and Endoscopy 206 PDU patients have been treated. Inclusion criterion for the main group (n=77) was duodenal ulcers, their dimension up to 1 cm, laparoscopic suture of perforated ulcer, fast track rehabilitation program implementation. The control group consisted of 129 patients who underwent open suturing of perforated ulcer followed by conventional treatment in postoperative period. In the main group (n=77) laparoscopic suturing of ulcerative defect with the use of Fast Track program was performed. Postoperative complication i.e. sutures failure was observed in 1 (1.3%) case. There were no lethal outcomes in the main group. Mean length of hospital-stay was 4.8 days. In 129 patients of the control group open suturing of the perforated ulcer and conventional postoperative therapy were applied. Postoperative surgical complications were absent in the control group; mortality rate was 2.3%. Mean length of postoperative hospital-stay was 8.1 days. Laparoscopic treatment of perforated ulcers facilitates application of fast track rehabilitation program in emergency patients. Fast track rehabilitation protocol after laparoscopic suturing of the perforated ulcer creates conditions for early discharge and is followed by good clinical and economic effects. Recurrent peptic ulcers are noted if antiulcer therapy is absent.

Pain management in knee arthroplasty: an overview

Perioperative pain management after knee arthroplasty has undergone a conceptual revolution in the last decade. Along with other exciting innovations, including minimally invasive techniques, computer-assisted procedures and a significant stride in tribology, understanding pain modulation and drug action at a molecular level is recognized as the game changer in arthroplasty surgeries. While most patients usually recover and experience pain relief within 3 mo after TKA, about 20% (10–34%) of the patients are left with an unfavorable long-term pain outcome. Fifty-two percent of patients report moderate pain and 16% report severe pain at rest 30 days after TKA, while pain at movement affects as much as 78% of the patients. Inability to adequately control postoperative pain causes undue suffering, inability to participate in fast-track rehabilitation programs, sleep disturbance (44% patients first 3 nights), delayed discharge, and the development of persistent postsurgical pain. The goal of this review article is to give an overview of the fundamental concept of surgical pain, the molecular mechanism of action of different drugs, evolution of the concept of preventive analgesia, and state of the art for current pain management. When combined and standardized, these factors allow arthroplasty surgeons to offer outpatient arthroplasty procedures.

Fast-Track Versus Standard Care in Laparoscopic High Anterior Resection

The value of fast-track (FT) multimodal recovery programs in improving hospitalization of surgical patients has been widely proved. The application of FT protocols to laparoscopic colorectal surgery seems to maximize the effects of the minimally invasive approach. The objectives of this randomized-controlled trial are to compare the short-term outcomes (bowel function, return to oral nutrition, day of discharge, fatigue, time to resume normal activities, functional capabilities, and readmission rate) of patients undergoing elective laparoscopic high anterior resection (HAR) following either a FT or a standard program. The prospective randomized-controlled trial included 52 consecutive patients undergoing elective laparoscopic HAR. Group 1 was treated with a FT rehabilitation program, and group 2 was treated with a standard care (SC) program. Patients were interviewed 14 and 30 days postoperatively. One patient in each group was excluded from the study. Mean hospital stay, time of first bowel movement, and bowel function resumption were significantly shorter in the FT group (P<0.05). Patients in the FT group referred more pain in day 0 versus patients in the SC group (P<0.05) even though the difference disappeared from day 1. Fatigue was significantly reduced at day 14 in the FT group compared with the SC group (P<0.01). Similarly, ability to resume the normal preoperative attitude (walking stairs, cooking, housekeeping, shopping, and walking outdoors) was significantly better at day 14 in the FT group (P<0.005). There was no significant difference between the 2 groups at day 30 for the same parameters. There were no readmissions in both the groups and no need for consultations from general practitioners. FT multimodal program is a safe approach effective on postoperative short-term outcome significantly reducing hospital stay. Early postoperative pain control needs to be optimized.

Fast-track rehabilitation program and conventional care after esophagectomy: a retrospective controlled cohort study

The purpose of this article is to evaluate fast-track rehabilitation program and conventional care after esophagectomy using a retrospective controlled cohort study in esophageal cancer patients. Fifty-five patients underwent fast-track rehabilitation program and 57 patients underwent conventional care after esophagectomy. Fast-track rehabilitation program was performed to patients who have early movement, epidural analgesia control, fluid infusion volume control and enteral nutrition for early discharge. The other 57 patients underwent conventional care after esophagectomy. The average of hospital stay and complications were calculated in the patients between the two groups. The median length of hospital stay in the patients was significantly shorter after fast-track rehabilitation program than after conventional care (7.7 vs 14.8 day, P < 0.01). The percentage of patients who developed complications was significantly lower 30 day after fast-track rehabilitation program than after conventional care (29.1 vs 47.4%, P < 0.05). 87.3% in patients of the fast-track rehabilitation program group and 54.4% in those of the conventional care group reported excellent to very good satisfaction with their pain control (P = 0.000). The fast-track rehabilitation program results in fewer complications, less postoperative pain, a reduction in the hospital length of stay, and quicker return to work and normal activities after esophagectomy.

Fast-track rehabilitation program vs conventional care after colorectal resection: A randomized clinical trial

To compare the fast-track rehabilitation program and conventional care for patients after resection of colorectal cancer. One hundred and six consecutive patients who underwent fast-track rehabilitation program were encouraged to have early oral feeding and movement for early discharge, while 104 consecutive patients underwent conventional care after resection of colorectal cancer. Their gastrointestinal functions, postoperative complications and hospital stay time were recorded. The restoration time of gastrointestinal functions in the patients was significantly faster after fast-track rehabilitation program than after conventional care (2.1 d vs 3.2 d, P<0.01). The percentage of patients who developed complications was significantly lower 30 d after fast-track rehabilitation program than after conventional care (13.2% vs 26.9%, P<0.05). Also, the percentage of patients who had general complications was significantly lower 30 d after fast-track rehabilitation program than after conventional care (6.6% vs 15.4%, P<0.05). The postoperative hospital stay time of the patients was shorter after fast-track rehabilitation program than after conventional care (5 d vs 7 d, P<0.01). No significant difference was observed in the re-admission rate 30 d after fast-track rehabilitation program and conventional care (3.8% vs 8.7%). The fast-track rehabilitation program can significantly decrease the complications and shorten the time of postoperative hospital stay of patients after resection colorectal cancer.

Tratamento do câncer colorretal em idosos extremos: relato de caso e revisão da literatura

Com o envelhecimento da população brasileira, cada vez mais o cirurgião colorretal se defrontará com pacientes chamados de idosos extremos, com idade superior a 75 ou 85 anos e apresentando diagnóstico de câncer colorretal (CaCR). A conduta é controversa diante desses casos. Este trabalho relata a abordagem de uma paciente de 97 anos com diagnóstico de adenocarcinoma de reto alto e faz uma revisão da literatura sobre o assunto. Esta paciente foi submetida à retossigmoidectomia paliativa vídeo-assistida, com incisão suprapúbica transversa para confecção da anastomose colorretal primária e retirada do espécime cirúrgico. Foi incluída no programa de reabilitação multimodal pós-operatória (fast-trac) para cirurgia colorretal, apresentou boa evolução e recebeu alta hospitalar no terceiro dia de pós-operatório. O estudo anatomopatológico da peça mostrou tratar-se de adenocarcinoma moderadamente diferenciado, invasor até a muscular própria e metastático em 2 de 12 linfonodos dissecados. De acordo com a literatura, em pacientes selecionados com mais de 75 anos, a cirurgia colorretal eletiva para CaCR pode ser realizada com taxa de morbimortalidade semelhante àquela de pacientes jovens, obtendo-se sobrevidas geral e livre de doença favoráveis. Comorbidades não definem isoladamente o prognóstico e nem contraindicam o procedimento.

Für wen ist PÜ &amp; E relevant – und wer ist ein Risikopatient?

This review discusses the clinical relevance of risk stratification to determine measures to prevent postoperative nausea and vomiting. The key question is whether PU&E is a problem related only to a small group of risk patients and whether risk stratification is a reasonable approach to deal with this problem. The application of risk scores to predict PU&E has been strongly advocated in the past years. These tools suggest that PU&E is mainly a problem of a small and well defined group of patients that can be identified and clearly separated from patients with no risk for PU&E. The need for applying these risk scores was based on the assumption that efficiency of antiemetic intervention mainly depends on the baseline risk for PU&E and that these are only justified at an increased risk (e.g. PU&E-risk > 60 %) where the number needed to treat is about 5 or lower. PU&E, on the other hand, are distressing and annoying symptoms for the patient. PU&E is a limiting factor for any approach to speed postoperative recovery and thus incompatible with so called fast-track rehabilitation programs. Thus, PU&E is relevant not only for high-risk patients but also for the great majority of patients with an intermediate risk for PU&E. The latter group, e.g. patients with a predicted risk to suffer from PU&E between 20 and 60 %, account for more than 80 % of all patients undergoing risk evaluation. Considering the high impact of PU&E for the individual patient, the small incidence of patients where the occurrence of PU&E can be ruled out with appropriate high probability, and finally the availability of several effective antiemetic measures all with a marked low incidence of side-effects, the authors of this review advocate a liberal policy for prophylactic administration of antiemetics. Prophylaxis against PU&E should be as self-evident as measures to limit postoperative pain. Omitting antiemetic prevention should only be considered if the estimated risk for PU&E is extremely low. All other patients in whom PU&E cannot be ruled out with high confidence should receive routine antiemetic prophylaxis.

Strukturiertes perioperatives Management (Fast-track Rehabilitation) bei konventionellen aorto-iliakalen Eingriffen

Fast-track rehabilitation programs have resulted in a decrease in mortality and morbidity after major surgical procedures, e. g., in colorectal surgery. It is not known whether fast-track rehabilitation can safely be applied in major vascular surgery. 35 patients (mainly ASA III) who underwent open aorto-iliac reconstruction (21 for abdominal aneurysm, 14 for aorto iliac occlusive disease) between May 2005 and June 2006 were treated with a fast-track protocol including PDA, early postoperative oral fluid and food supply, early postoperative mobilisation, all starting on the day of operation. The average daily oral fluid amount, duration of mobilisation, step of oral nutrition, day of first defecation, PONV, pain levels while resting, under effort and mobilisation, and fatigue were monitored. The 30-day mortality was 0%, overall morbidity was 14.8% with 9% pulmonary, 2.9% cardiac and 2.9% renal complications. Mobility was safely achieved. The oral fluid consumption was 329 mL on the day of operation and 1160 mL on the second day after operation. 33 patients (94%) achieved total oral nutrition on day four after operation. The average pain level in all categories and the fatigue were below 4 on the VAS. Fast-track rehabilitation can safely be applied to patients undergoing conventional aorto-iliac reconstruction. Early onset of oral nutrition and mobilisation influence the fatigue in a positive way. Thoracal PDA leads to acceptable pain levels.

Clinical Outcomes and Cost Analysis of a “Fast Track” Postoperative Care Pathway for Ileal Pouch-Anal Anastomosis. A Case Control Study

Traditional length of hospital stay after ileal pouch-anal anastomosis is 8 to 15 days. Fast track rehabilitation programs reduce stay, but there are concerns that readmission and complication rates may be increased. This study evaluated a fast track pathway after ileoanal pouch surgery. One hundred three consecutive patients underwent ileal pouch-anal anastomosis on two colorectal services using a fast track protocol with early ambulation, diet, and defined discharge criteria. Direct hospital costs and 30-day and long-term complication data were collected. Patients were matched to controls managed with traditional care pathways by other colorectal staff. Matching was established for 97 patients. Fast track patients had shorter hospital stay than controls (median 4 vs. 5 days; mean 5.0 vs. 5.9, P = 0.012). Readmission and recurrent operation rates were similar (24 vs. 20 percent, P = 0.49, and 9 vs. 10 percent, P = 0.8, fast track vs. control, respectively). Median direct costs per patient (US$) within 30 days were lower with fast track (5692 vs. 6672, P = 0.001), primarily because of reductions in postoperative management expenses. Complication rates, including pouch failure, bowel obstruction, pouchitis, and anastomotic stricture were comparable. Early discharge (< or = 5 days from surgery) occurred in 79 (77 percent) fast track patients. Failure with early discharge was associated with male gender, reoperations, and anastomotic complications. Fast track protocol after ileoanal pouch surgery reduces length of stay and hospital costs without increasing complication rates. Successful early discharge usually signals a benign postoperative course.

Réhabilitation après chirurgie viscérale

A combined strategy of anesthetic and surgical care defines postoperative rehabilitation, which aims to accelerate recovery from surgery, shorten convalescence, and reduce postoperative morbidity. Preoperative and early postoperative oral feeding, a relatively "dry" fluid regimen, and the avoidance of or early removal of drains, gastric tubes and bladder catheters all contribute to decreasing postoperative morbidity after abdominal surgery. Postoperative pain control, prevention of nausea and vomiting, shortening the duration of postoperative ileus, and early ambulation can also help to decrease postoperative morbidity. The use of multimodal fast-track clinical rehabilitation programs should improve outcomes and quality of life, reduce hospital stays, and save money.

Fast-track giant paraoesophageal hernia repair using a simplified laparoscopic technique

Operation for paraoesophageal hernia may be associated with severe complications, especially when performed as an open technique. Furthermore, it is not settled whether the procedure should be performed in combination with an antireflux procedure. Fast-track rehabilitation programs in other operations have been associated with shortened hospital stay and reduced complications compared with conventional care programs. The aim of the present study was to combine a simplified surgical technique with a fast-track rehabilitation program for repair of giant paraoesophageal hernia. During a 2-year period, 21 patients underwent laparoscopic paraoesophageal hernia repair with a fast-track rehabilitation program. We did not use an antireflux procedure or repaired the enlarged hiatus in any of the patients. All patients had the hernia sac dissected and a gastropexy to the anterior abdominal wall. Median operation time was 75 min (range 65-120), and the median postoperative hospital stay was 2 days (1-20), where 10 patients stayed for only 1 day. Two patients received postoperative blood transfusions, and the same 2 patients also developed postoperative pneumonia treated with penicillin. Before operation, 4 patients were treated with proton pump inhibitors for reflux symptoms, but after operation, only 1 patient continued treatment with omeprazol 20 mg daily. At barium x-ray follow-up after 3 months, 3 patients had a partial recurrence of a paraoesophageal hernia, but none of them had any symptoms and therefore did not undergo further treatment. Using a fast-track rehabilitation program and a simplified laparoscopic surgical technique, repair of giant paraoesophageal hernias can be performed with a short hospital stay and minimal complications.

Efficacy and Safety of Fast-Track Recovery Strategy for Patients Undergoing Laparoscopic Nephrectomy

Factors that adversely affect early recovery after major laparoscopic procedures include ileus, pain, nausea, emesis, and fatigue. The objective of this randomized controlled study was to evaluate the impact of a multimodal fast-track (FT) rehabilitation program on recovery and length of hospital stay after laparoscopic nephrectomy. Thirty patients undergoing laparoscopic nephrectomy received either conventional care (control) or an FT recovery program. All patients received a standardized anesthetic technique and patient- controlled analgesia (morphine) for postoperative pain control. In the FT group, patients received premedication with rofecoxib and ranitidine, local anesthesia was administered at the ports and renal fosa during surgery, and postoperative non-opioid analgesic and gastrokinetic drugs were administered as part of an early enteral nutrition and mobilization program. During the postoperative period, pain and nausea were assessed at specific time intervals. In addition, recovery room and hospital discharge times, the need for rescue analgesics and antiemetics, patient satisfaction with pain management and quality of recovery, and side effects were recorded daily for 3 days after surgery. Patients were discharged home when they met previously defined discharge criteria. The FT group was discharged earlier from the recovery room (74+/-23 v 103+/-47 minutes) and the hospital (41+/-11 v 59+/-11 hours). Pain and nausea scores were consistently lower in the FT group during the first 48 hours after surgery. In addition, the requirement for antiemetic rescue therapy during the first 24 hours was reduced in the FT group (15% v 58%). The FT group also received less morphine during the first 2 postoperative days (14+/-16 v 40+/-24 mg). Finally, patient satisfaction with postoperative pain control was significantly higher in the FT group. A multimodal approach to minimizing postoperative side effects led to a reduced recovery room and hospital stay, as well as better pain control and patient satisfaction after laparoscopic nephrectomy.

Evaluation of a fast-track cardiac rehabilitation program after heart transplantation

Evaluation of a fast-track cardiac rehabilitation program after heart transplantation