Flatus Time Research Articles

Application of enhanced recovery after surgery (ERAS) protocol in radical gastrectomy: a systemic review and meta-analysis

PurposeThis study aimed to assess the safety and efficiency of the enhanced recovery after surgery (ERAS) protocol in radical gastrectomy.MethodsStudies published before February 2019 were searched from EMBASE, PubMed, Cochrane...

2347 A Comparison of Laparoscopic Versus Laparotomy Management for Adnexal Masses During Pregnancy: A Retrospective Study With 16-Year Experience

Study Objective To evaluate the surgical, obstetric outcomes between laparoscopic and laparotomy management for adnexal mass during pregnancy. Design Retrospective comparative study. Setting University tertiary care referral center for endoscopic surgery. Patients or Participants Eighty-six pregnant women who underwent 86 operations for suspected adnexal pathology at our institute. Laparoscopy was performed during the first trimester in 13 patients, second trimester in 33 patients. The remaining 40 patients underwent laparotomy, 8 during the first trimester, 31 during the second trimester and 1 during third trimester. Interventions Laparoscopy or laparotomy for the management of adnexal masses during pregnancy from January 1996 to March 2012. Measurements and Main Results Operative and postoperative maternal complications, miscarriage, congenital malformations, and newborn long-term outcome. Results The laparoscopy group had a significantly shorter mean operative time (68.5±4.2 vs 49.9±3.4 min, P=0.0008), lower mean blood loss (19.9±2.3 vs 45.3±4.6 ml), shorter mean flatus time after operation (22.0±0.7 vs 43.1±2.1 h) and mean hospital stay (2.8±0.1 vs 6.6±0.2 days, P=0.004) than the laparotomy group. All group patients didn't require a blood transfusion. In multivariate analysis, there was no significant difference between laparoscopy and laparotomy group in obstetric outcomes, including preterm delivery and miscarriage rate, after adjusting for confounding factors, such as gestational age at surgery, emergency surgery and mass size. The median follow-up time was 3.5 years (range, 1.5-11.5 years). The median age of the child was 2.5 years (range, 1-9.5 years). All babies were healthy. Conclusion In this retrospective study, the successful outcome suggests that operative laparoscopy for adnexal masses performed during pregnancy is safe and feasible when performed by experienced surgeons. Procedures in the second trimester without emergency indications is preferable.

A Comparison of Totally Laparoscopic Pylorus Preserving Gastrectomy and Laparoscopy-Assisted Pylorus Preserving Gastrectomy for Early Gastric Cancer.

PurposePylorus-preserving gastrectomy (PPG) is known to have both nutritional and functional advantages over distal gastrectomy for the treatment of early gastric cancer. Although laparoscopic surgery is a popular choice, intracorporeal anastomosis is a newly developed technique that is gaining popularity. This study aimed to determine any differences in the oncological, surgical, and functional outcomes of intracorporeal and extracorporeal anastomosis after PPG.MethodsA retrospective analysis was performed on 90 patients for cT1N0 gastric cancer who underwent laparoscopic pylorus preserving gastrectomy from January 2015 to June 2017 at the OOO, Korea; 38 patients underwent intracorporeal (TLPPG) and 52 underwent extracorporeal (LAPPG) anastomosis. The postoperative oncological, surgical, and functional outcomes were compared between the two groups. In order to compare the outcomes in obese patients, the postoperative and functional outcomes in patients with a BMI of ≥25, and in those with abdominal wall thickness measuring ≥28 mm, were evaluated.ResultsThe TLPPG group showed a significantly reduced wound size (4 cm (3~4) vs 5 cm (5~6), p<0.001) and had fewer wound complaints than the LAPPG group (0.0% vs 15.4%, p=0.01). Postoperative complications were not significantly different between the two groups. In the BMI ≥25 subgroup, the first flatus time after operation was shorter in the TLPPG group (2.9±0.5 vs 3.5±0.8 days, p=0.04).ConclusionThe study demonstrates that both TLPPG and LAPPG are safe and feasible, and that there is a potential benefit for obese patients.

Efficacy of Celiac Branch Preservation in Billroth-Ⅰ Reconstruction After Laparoscopy-Assisted Distal Gastrectomy

BackgroundThe goal of the present retrospective study was to elucidate the efficacy of conserving the celiac branch (CB), which can reduce the adverse reactions of Billroth-Ⅰ (B-Ⅰ) restoration after the laparoscopy-assisted distal gastrectomy (LADG). MethodsTwo hundred thirty-three patients with gastric cancer underwent B-Ⅰ reconstruction after LADG with dissection 2 lymphadenectomy from July 2005 to July 2012 and were monitored for 5 y. The patients were separated into 2 groups: celiac branch preserved (P-CB) group (n = 98) and celiac branch resected (R-CB) group (n = 135). In addition to patient information, tumor features, and surgical details, short-term and long-term variables such as bowel condition, surgical complications, and endoscopy findings were evaluated. ResultsIn short-term efficacy, the time of first flatus and liquid ingestion were slightly shorter in the P-CB group than in the R-CB group (3.84 ± 0.74 versus 4.38 ± 0.71, P = 0.0001; 5.04 ± 1.07 versus 5.67 ± 1.10, P = 0.0001). For long-term efficacy, the incidences of chronic diarrhea, gastroparesis, residual food, bile reflux, and reflux esophagitis were less in the P-CB group compare with the R-CB group (6.1% versus 22.2%, P = 0.001; 5.1% versus 17.8%, P = 0.004; 4.1% versus 17.8%, P = 0.004; 8.2% versus 17.8%, P = 0.036; 8.2% versus 17.8%, P = 0.036). Other parameters such as postoperative ileus and gallstones had a better efficacy trend in the P-CB group but did not suggestively vary among the groups. ConclusionsThe CB has an imperative part in the gastrointestinal motility, and celiac preservation mainly exerts long-term efficacy in patients who underwent B-I surgery with LADG.

Influence of preoperative enema application on the return of gastrointestinal function in elective Cesarean sections: a randomized controlled trial

Aim There is an extensive literature on the mechanical bowel preparation by an enema in colorectal, abdominal, and gynecologic surgeries that provide evidence against the use of enema. There are, however, few studies investigating the effect of enema prior to elective Cesarean sections. The aim of this study is to investigate whether preoperative enema facilitates the return of gastrointestinal activity in pregnant women undergoing elective Cesarean section. Materials and methods The surgeon-blinded prospective randomized controlled study included 225 elective Cesarean patients between the ages of 18 and 44. The patients were randomized into two groups: those who had enema preoperatively (n = 114) and those who did not (n = 111). The outcome measures were first bowel sound time and first flatus time, the length of hospital stay, the rate of mid ileus symptoms, and additional analgesic and antiemetic need. Results In the non-enema group, the time of the first bowel sound, flatus time, length of hospital stay, the rates of additional analgesic need, additional antiemetic need, and mild ileus symptoms were respectively 10.5 ± 5.8 hours, 16.0 ± 7.6 hours, 1.9 ± 0.3 days, 8.1%, 7.2%, and 2.7%. For the enema group, the same parameters were respectively 11.6 ± 4.7 hours, 17.5 ± 6.5 hours, 1.8 ± 0.3 days, 7%, 6.1% ,and 1.8%. For all parameters, the difference between the groups was not statistically significant (p values were respectively .09, .12, .8, .79, .68, and .26). Conclusions The study suggests that preoperative enema in elective cesarean sections does not prevent postoperative gastrointestinal complications and does not shorten the recovery of bowel movements or length of hospital stay.

Effect of early oral feeding on gastrointestinal motility in patients undergoing colorectal resection: a meta-analysis of randomized clinical trials

Background: The use of early oral feeding (EOF) to enhance the recovery of gastrointestinal (GI) motility after elective colorectal cancer surgery remains controversial. There was no updated meta-analysis to determine the efficacy and safety of this invention. Methods: Randomized controlled trials (RCTs) were identified from PubMed, Embase, and the Cochrance Central Register of Controlled Trials (CENTRAL). Eleven RCTs (1,216 participants) were included in our meta-analysis. Results: The EOF was associated with a shorter time of first flatus (MD =−0.58, 95% CI: −0.70 to −0.47, P&lt;0.00001, I 2 =19%), shorter first defecation (MD =−0.79, 95% CI: −1.00 to −0.59, P&lt;0.00001, I 2 =0%), and reduced length of hospital stay (MD =−1.48, 95% CI: −2.11 to −0.85, I 2 =78%) compared to conventional oral feeding (COF). There was no significant difference between the EOF and COF group in the incidence of nausea, vomiting, nasogastric tube (NGT) reinsertion, the risk of wound infection, and the occurrence of pneumonia and anastomotic dehiscence. The risk of total postoperative complications was much lower in the EOF group than the COF group [relative risk (RR) 0.59, 95% CI: 0.48 to 0.73, I 2 =46%, P&lt;0.00001]. Conclusions: Our findings suggest that EOF is appropriate for patients after elective colorectal cancer surgery and it is good for the recovery of GI motility.

The Impact of Alvimopan on Return of Bowel Function After Major Spine Surgery - A Prospective, Randomized, Double-Blind Study.

Pain management following major spine surgery requires high doses of opioids and is associated with a risk of opioid-induced constipation. Peripheral mu-receptor antagonists decrease the gastrointestinal complications of perioperative systemic opioid administration without antagonizing the analgesic benefits of these drugs. To investigate the impact of alvimopan in opioid-naive patients undergoing major spine surgery. Patients undergoing>3 levels of thoracic and/or lumbar spine surgery were enrolled in this prospective, randomized, double-blind study to receive either alvimopan or placebo prior to and following surgery. Opioid consumption; pain scores; and time of first oral intake, flatus, and bowel movement were recorded. A total of 24 patients were assigned to the active group and 25 were assigned to the placebo group. There was no significant difference in demographics between the groups. Postoperatively, the alvimopan group reported earlier time to first solid intake [median (range): alvimopan: 15 h (3-25) vs placebo: 17 h (3-46), P<.001], passing of flatus [median (range): alvimopan: 22 h (7-63) vs placebo: 28 h (10-58), P<.001], and first bowel movement [median (range): alvimopan: 50 h (22-80) vs placebo: 64 h (40-114), P<.001]. The alvimopan group had higher pain scores (maximum, minimum, and median); however, there was no significant difference between the groups with postoperative opioid use. This study shows that the perioperative use of alvimopan significantly reduced the time to return of bowel function with no increase in postoperative opioid use despite a slight increase in pain scores.

Application of Overlap anastomosis to Billroth I digestive tract reconstruction after laparoscopic distal gastrectomy in gastric cancer

Objective: To investigate the application value of Overlap anastomosis in Billroth I digestive tract reconstruction after laparoscopic distal gastrectomy in gastric cancer. Methods: Clinical data of 68 stage T1-2 gastric cancer patients undergoing laparoscopic distal gastrectomy for D2 radical gastrectomy from January 2015 to January 2016 at China Japan Union Hospital of Jilin University were retrospectively analyzed. Inclusion criteria: (1) no distant metastasis of gastric cancer confirmed by gastroscopy and pathology before surgery; (2) T1-2 tumor with diameter <3 cm; (3) the lesion locating in the antrum of the stomach with distance >1 cm from the pylorus, and no invasion into middle area; (4) R0 resection confirmed by postoperative pathology; (5) no history of abdominal surgery. Among 68 cases,23 cases were in Overlap anastomosis group and 45 cases in Billroth I anastomosis group. D2 lymph node dissection and distal gastrectomy were performed in both groups. In the Overlap anastomosis group, the duodenum and stomach were severed by a linear stapler under endoscopy, and the residual gastric curve anastomotic opening was selected. According to the tension between the duodenum and the remnant stomach, the anastomotic opening was selected at the upper edge of the remnant duodenum, and the anastomosis between the posterior wall of the remnant stomach and the upper wall of the duodenum was completed by placing the stapler under endoscopy. Then the common opening was closed and the remnant duodenum was resected. In the traditional Billroth I anastomosis group, pneumoperitoneum was discontinued after amputation of the duodenum under laparoscopy. The median incision of the upper abdomen was 9-12 cm. The distal stomach was pulled out to complete the excision of specimens, the extraction of specimens and Billroth I digestive tract reconstruction. The intraoperative and postoperative conditions of the two groups were compared with student t test (continuous variable) and chi-square test (categorica variable). Results: Of the 68 patients,39 were males and 29 were females,with age of (65.5±10.2)(51 to 77)years. Differences in baseline data between Overlap group and Billroth I group were not statistically significant (all P>0.05). Laparoscopic surgery was successfully performed in both groups without conversion to open operation. As compared with the Billroth I group, the Overlap group had significantly shorter operation time [(149.8±10.1) minutes vs. (169.8±15.3) minutes, t=5.658,P=0.008], shorter anastomotic time of digestive tract reconstruction [(31.2±3.8) minutes vs. (36.3±3.3) minutes, t=3.389, P=0.003] and shorter abdominal incision length [(4.5±0.9) cm vs.(11.0±2.3) cm, t=13.244,P=0.004]. There were no significant differences between two groups in intraoperative blood loss [(92.9±22.4) ml vs. (87.0±7.3) ml,t=1.186,P=0.366], number of lymph node dissected (28.4±5.7 vs. 27.3±5.2, t=0.838, P=0.383), postoperative flatus time [(4.4±2.1) days vs.(4.2±1.8) days, t=0.391, P=0.563], morbidity of postoperative complication [4.3%(1/23) vs. 6.7%(3/45), χ2=0.148,P=0.701]. All the patients were followed up for 28±10 (10-46) months. There were no long-term complications, recurrence or death in two groups. Conclusion: Overlap anastomosis in Billroth I digestive tract reconstruction after laparoscopic distal gastrectomy is safe and effective, and can reduce the anastomosis time.

Safety of early oral feeding after total laparoscopic radical gastrectomy for gastric cancer (SOFTLY-1): a single-center randomized controlled trial.

Objectives: The aim of this study is to explore the safety and feasibility of early oral feeding (EOF) on short-term postoperative outcomes.Trial design: A prospective randomized non-inferiority trial.Materials and methods: From August 27, 2015 to March 31, 2017, 100 consecutive patients with gastric cancer in Xijing Hospital were recruited. Patients undergoing total laparoscopic radical gastrectomy (TLRG) received either EOF group or delayed oral feeding (DOF group). The endpoints were anastomotic leakage, the recovery of bowel function, the postoperative complications and costs. The process of randomization used a computer-generated sequence that was kept in a sealed envelope by a nurse that did not participate in the trial. None of the participants, administrators of interventions and those assessing outcomes was blinded.Results: Ultimately, 51 patients were in EOF group and 49 in DOF group, which both are comparable. The postoperative hospital stay in EOF group was significantly lower than DOF group (5.18±1.47 days vs 6.18±2.46 days, P=0.016). Furthermore, there was a trend for a reduction in the time of first flatus (10.3 hrs) and defecation (12.7 hrs) in EOF group compared to DOF group, but it was not statistically significant. Meanwhile, there were no significant differences in postoperative complications between two groups. One patient in the EOF group developed a fistula in the surgical remnant, which was recorded as other leakages; there was no difference between the two groups (P=0.582).Conclusion: EOF does not seem to be more harmful than DOF, and might significantly improve the short-term outcomes for patients receiving TLRG.

TME for rectal cancer: consecutive 70 patients treated with laparoscopic and robotic technique-cumulative experience in a single centre.

From January 2011 to December 2015, 70 consecutive patients underwent either laparoscopic surgery (LS) or robotic surgery (RS) total mesorectal excision (TME) for malignancy. Data were prospectically recorded in a dedicated local database including ASA score, age, operative time, conversion rate, re-operation rate, early complications, length of stay, and pathological results. We enrolled 70 consecutive patients, 35 treated with LS (18M, 17 F), 35 treated with RS (23M, 12 F). Median total operative time was 225min in LS group (IQR 194-255) and 252.5min for RS group (IQR 214-300). Median first flatus time was 2days for LS group (IQR 1-3) and 1day for RS group (IQR 1-2). Stool discharge time (median) was 4days for LS group (IQR 2-5) and 2days for RS group (IQR 1-3). Length of stay (median) was 8days in LS group (IQR 7-10) and 7days in RS group (IQR 5-8). It was not found any statistically significant difference between the two groups when we analyzed the number nodes harvested the postoperative complications. The 30day mortality was 0% in both two groups. The conversion rate for LS group was 23% (8/35 pts) and that for RS group was 0% (0/35). The RS may overcome technical limitations of LS. In our experience, it is a feasible and safe technique, it achieves better clinical outcomes due to the lower conversion rate compared to LS, although with higher costs.

Efficacy of intravenous lidocaine in improving post-operative nausea, vomiting and early recovery after laparoscopic gynaecological surgery.

Post-operative nausea and vomiting (PONV) is a major peri-operative complication. It has numerous adverse consequences that seriously affect the post-operative recovery of patients. The aim of the present study was to investigate the efficacy of intravenous lidocaine in improving PONV and recovery after laparoscopic gynaecological surgery. A total of 40 patients were randomly assigned to 2 groups: Group L (lidocaine group) and Group C (control group). The patients in Group L received intravenous lidocaine throughout the operation, while patients in Group C were given a saline infusion. Vital signs, recovery time, extubation time, dosage of remifentanil, first flatus time and defecation time of each patient were recorded. The incidence of PONV after surgery was also recorded. The recovery of the patients was evaluated by using the quality of recovery score (QoR-40). The total dose of remifentanil was significantly lower in Group L (P<0.05). However, the recovery time and extubation time were shorter in Group C (P<0.05). The first flatus time and defecation time were longer in Group C (P<0.05). The mean arterial pressure and heart rate in Group L were lower and more stable (P<0.05). At 6 h after surgery, the incidence of PONV was significantly lower in Group L vs. that in Group C (P<0.05). The QoR-40 score in Group C was significantly lower at 1 and 3 days after the operation compared with that in Group C (P<0.05). In conclusion, intravenous lidocaine administered to patients undergoing laparoscopic gynaecological surgery may reduce PONV and supports their early recovery [trial registration number in Chinese Clinical Trial Registry: ChiCTR-IOR-17010782 (March 5, 2017)].

Effectiveness of Parecoxib Sodium Combined with Transversus Abdominis Plane Block for Pain Management After Hepatectomy for Hepatocellular Carcinoma: A Prospective Controlled Study.

BackgroundThis study aimed to investigate the effectiveness of perioperative parecoxib sodium combined with transversus abdominis plane (TAP) block on postoperative pain management following hepatectomy in patients with hepatocellular carcinoma (HCC).Material/MethodsOne hundred patients with HCC who underwent hepatectomy were randomized into a study group (n=51) and a control group (n=49). The study group received 40 mg of parecoxib sodium 30 minutes before anesthetic induction, and 150 mg of 0.375% ropivacaine with 5 mg dexamethasone as TAP inhibitors, before closing the abdominal incision. The control group received 40 mg of placebo 30 minutes before anesthetic induction, without TAP block. Postoperatively, all patients received patient-controlled intravenous analgesia (PCIA) and evaluation with subjective visual analog scale (VAS) pain scores. Data on adverse events, postoperative ambulation (>6 hours/day), time of flatus and defecation, and hospitalization duration were recorded.ResultsPain scores of the study group were significantly lower compared with the control group on the first three postoperative days. No significant differences were found between the two groups in terms of adverse events. In the study group, the number of cases of postoperative ambulation was significantly more than the control group. The onset of flatus and defecation and duration of hospital stay in the study group were significantly shorter in the study group compared with the control group.ConclusionsParecoxib sodium combined with TAP block effectively reduced postoperative pain, improved ambulation, improved gastrointestinal function, and shortened hospitalization time following hepatectomy in patients with HCC without adverse effects.

The Early Study to Laparoscopic Radical Resection of the Mid Transverse Colon Cancer

Objective: To explore the safety and the short-term curative effect of the application of assisted laparoscopic radical resection for the mid transverse colon cancer. Methods: A retrospective analysis of 25 cases clinical data of radical resection of mid transverse colon cancer from March 2006 to March 2014 in our hospital. Cases were divided into two groups, laparoscopic group with 12 cases and open group with 13 cases. Intra-operative observation indexes (operation time, bleeding volume, the number of dissected lymph nodes), post-operative recovery indexes (flatus time, liquid food intake time, ambulation time, hospitalization time), post-operative complication (incision site infection, abdominal bleeding, intra-abdominal infection, anastomotic fistula, intestinal obstruction and re-hospitalization within 30 days, mortality) and patient’s five-year overall survival were observed in two groups. Results: Operation methods including the principle of complete mesocolic excision (CME), colon dissection along the anatomical plane and safe anastomosis method were applied in Laparoscopic group. Average surgery time of Laparoscopic group was longer than open group, but there was no statistically significant difference between the two groups (p > 0.05). Intra-operative blood loss in the Laparoscopic group was obviously lower than open group; the difference was statistically significant (p < 0.05). The number of lymph node dissection in laparoscopic group was higher than open group (p < 0.05). Laparoscopic group in the postoperative recovery index including recovery of bowel function, ambulation time and hospitalization time was shorter than that of the open group after operation (P < 0.05). Conclusion: The use of laparoscopic radical resection for the mid transverse colon cancer resulted in acceptable short term curative effects.

The ST-36 Acupressure Increased Gut Motility To Sectio Caesarea Patients with Subarachnoid Block Anesthesia

Postoperative patients with Subarachnoid Block anesthesia will experience paralytic ileus. Various efforts to overcome this have been carried out, including early mobilization, chewing gum, warm compresses, and acupuncture. The actions taken have not yet shown maximum results. This study aimed to analyze the effect of ST-36 acupressure on gut motility and flatus time in postoperative patients with Subarachnoid Block anesthesia. This research used Quasi-Experiment with pretest-posttest group design. Population in this research was post operation patient with Subarachnoid Block anesthesia in Sidoarjo Hospital. A sample of 14 respondents in control group and 14 respondents in experimental group were obtained using purposive sampling technique. Data retrieval was done by criteria using lidodex 100mg/2ml anesthetic or 5% lidocain + adrenaline. Data were analyzed using independent t test. The result showed that there was difference average frequency of gut motility between control group and experimental group after given intervention ST-36 acupressure (p=0.013). The time of flatus showed that there were no significant differences in the two groups (p = 0.262). It can be concluded that ST-36 acupressure can increase gut motility, whereas it did not affect flatus time.

Probiotics for preventing postoperative infection in colorectal cancer patients: a systematic review and meta-analysis.

Postoperative infection has seriously affected the prognosis of cancer patients, while probiotics have been increasingly used to prevent postoperative infection in clinical practice. This study aimed to evaluate the preventive effect of probiotics on infection after colorectal cancer (CRC) surgery. Related clinical trial reports were collected from Pubmed, Embase, Cochrane Library as well as China National Knowledge Infrastructure (CNKI) databases. These reports were then strictly screened, and information as well as data were extracted. Finally, the enrolled studies were evaluated by systematic review and meta-analysis using STATA v11 and Revman v5.2. Probiotics administration contributed to the reduction of overall infection rate after colorectal surgery, with a pooled odds ratio (OR) of 0.51 (95% CI: 0.38-0.68, P= 0.00). Meanwhile, the incidence of incision infection (pooled OR = 0.59, 95% CI 0.39-0.88, P= 0.01) and pneumonia (pooled OR = 0.56, 95% CI 0.32-0.98, P= 0.04) as well as the first flatus time (SMDs = - 0.70, 95% CI - 1.13-- 0.27, P= 0.002) were also reduced by probiotics. In addition, urinary tract infection, anastomotic leakage, and duration of postoperative pyrexia were also analyzed, which displayed no statistical differences compared with those of control. Probiotics have potential efficacy on preventing postoperative infection and related complications in cancer patients undergoing colorectal surgery.

Effect of Trocar Site Bupivacaine Administration, Time of First Passage of Flatus, and Duration of the Surgery on Postoperative Pain After Sleeve Gastrectomy: a Case Control Study.

The effect of local anesthetic applications to trocar sites on postoperative pain control has been studied many times, and different results have been obtained. We planned a controlled study evaluating the effect of bupivacaine administration and other contributing factors on postoperative pain following sleeve gastrectomy. Patients who underwent laparoscopic sleeve gastrectomy were included in the study. Patients were randomized into two groups according to local application as either a local or non-local group. Also, the patients were grouped separately from local group allocation according to time to first passage of flatus (< 12h, ≥ 12h) and duration of surgery (> 50min, ≤ 50min). A visual analogue scale (VAS) was performed at 4, 8, 12, 24, and 48h postoperatively. Opioid analgesics (pethidine HCl) were administered if the patient's VAS score was greater than 5. Demographic characteristics, such as age, gender, height, weight, body mass index (BMI), and operative time, were recorded. Demographic characteristics and VAS scores were compared between groups. A total of 168 patients were included in the study. Of these, 84 patients were included in both of the local and non-local groups. The demographic characteristics between groups were similar. There was no significant difference between groups in terms of VAS scores (p > 0.05). In the analysis according to the time to first passage of flatus, the 48th-hour VAS scores were lower in the early flatus group (p = 0.036). According to the duration of surgery, first flatus was detected earlier, and VAS scores at the 8th and 12th hours were less in the short operation group (p < 0.001, p = 0.005, p = 0.031, respectively). Although we did not show any effect of local administration of bupivacaine in LSG on pain, we concluded that other factors like duration of surgery and first flatus time have an impact on this issue.

Optimized strategy of anesthesia for modified radical mastectomy: transverse thoracic muscle plane-thoracic nerve block combined with general anesthesia

Objective To evaluate the efficacy of transverse thoracic muscle plane-thoracic nerve block combined with general anesthesia when used for modified radical mastectomy. Methods Sixty female patients, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, aged 45-63 yr, weighing 48-72 kg, scheduled for elective modified radical mastectomy, were divided into 3 groups (n=20 each) using a random number table method: thoracic nerve block-general anesthesia group (group P+ G), transverse thoracic muscle plane-thoracic nerve block-general anesthesia group (group T+ P+ G) and general anesthesia group (group G). Anesthesia was induced with midazolam, propofol, fentanyl and cisatracurium and maintained with sevoflurane, fentanyl and cisatracurium.Thoracic nerve block typeⅠ and Ⅱ was performed after implanting laryngeal mask airway in group P+ G.Transverse thoracic muscle plane block was performed after performing thoracic nerve block typeⅠ and Ⅱ in group T+ P+ G.Flurbiprofen 50 mg was intravenously injected after operation as a rescue analgesic to maintain the Visual Analogue Scale score≤3.The consumption of opioids, emergence time and time for removal of the laryngeal mask airway were recorded.Ramsay sedation score was recorded at 10 min after removal of the laryngeal mask airway.The requirement for rescue analgesia, time of passing flatus and development of nausea and vomiting within 24 h after operation were recorded. Results Compared with group G, the emergence time, time for removal of the laryngeal mask airway and time of passing flatus were significantly shortened, and the Ramsay sedation score, consumption of fentanyl and requirement for rescue analgesia were decreased in P+ G and T+ P+ G groups (P 0.05). Conclusion Transverse thoracic muscle plane-thoracic nerve block combined with general anesthesia can provide satisfactory perioperative analgesia and is helpful in improving prognosis for the patients undergoing modified radical mastectomy. Key words: Thoracic nerves; Nerve block; Anesthesia, general; Breast neoplasms; Transversus thoracic muscle

Effect of multimodal analgesia with diclofenac sodium on cognitive function following radical resection for colon cancer in elderly patients

Objective To evaluate the effect of multimodal analgesia with diclofenac sodium on cognitive function following radical resection for colon cancer in elderly patients. Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of either sex, aged 65-80 yr, weighing 45-85 kg, scheduled for elective open sigmoidectomy under general anesthesia, were divided into control group and test group by a random number table method with 30 patients in each group.In test group, diclofenac sodium suppository was administrated rectally before surgery and placed at about 2 to 3 cm above the anal dentate line, diclofenac sodium suppository 50 mg was given at 2 h before surgery and 4 h after surgery, followed by administration once every 12 h until 2 days after surgery.Patient-controlled intravenous analgesia was performed after operation, dezocine 5 mg was intravenously injected when VAS score was more than 4 points within 48 h after surgery.The concentrations of serum interleukin-6 (IL-6), IL-8 and tumor necrosis factor-alpha (TNF-α) were measured by enzyme-linked immunosorbent assay before surgery (T0) and at 2, 6, 12, 24 and 48 h after surgery (T1-5). The postoperative requirement for rescue analgesia, postoperative analgesia satisfaction score, time of passing the first flatus and first postoperative off-bed time were recorded.Cognitive function was assessed at 1 day before surgery and 7 days after surgery, and the occurrence of postoperative cognitive dysfunction was recorded. Results Compared with control group, the serum concentrations of IL-6 at T2-5, IL-8 at T1-5 and TNF-α at T2-4 were significantly decreased, the requirement for rescue analgesia and incidence of postoperative cognitive dysfunction were decreased, and the time of passing the first flatus and first postoperative off-bed time were shortened in test group (P<0.05). Conclusion Diclofenac sodium for multimodal analgesia can improve cognitive function following radical resection for colon cancer in elderly patients. Key words: Diclofenac; Analgesia; Cognition disorders; Colonic neoplasms; Aged

Effects of TEAS combined with general anesthesia versus epidural block combined with general anesthesia on recovery of patients undergoing laparoscopic radical resection of colorectal cancer

Objective To compare the effects of transcutaneous electrical acupoint stimulation (TEAS) combined with general anesthesia and epidural block combined with general anesthesia on the recovery of patients undergoing laparoscopic radical resection of colorectal cancer. Methods Eighty-four patients of both sexes, aged 35-64 yr, with body mass index of 18-25 kg/m2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective laparoscopic radical resection of colorectal cancer, were divided into 3 groups (n=28 each) using a random number table method: general anesthesia group (group G), TEAS combined with general anesthesia group (group TG), and epidural block combined with general anesthesia group (group EG). In group TG, patients received continuous TEAS of bilateral Neiguan, Hegu, Zusanli, Shangjuxu and Xiajuxu acupoints starting from 30 min before anesthesia induction until the end of surgery at a frequency of 2/100 HZ and intensity of 3-8 mA with disperse-dense waves.In group EG, an epidural catheter was placed at L1, 2 and advanced for 3 cm in the epidural space in cephalad direction, 2% lidocaine 3 ml was given as a test dose, 0.375% ropivacaine 6-10 ml was injected into the epidural space, the level of anesthesia was adjusted to T6, and then 0.375% ropivacaine 5 ml/h was infused to the epidural space until the end of operation.Patients were endotracheally intubated after routine induction of general anesthesia and mechanically ventilated, and combined intravenous-inhalational anesthesia was used to maintain anesthesia.The Quality of Recovery (QoR-15) score was recorded on 1 day before surgery and 1-3 days after surgery.The development of nausea and vomiting, cognitive decline and requirement for rescue analgesics was recorded within 3 days postoperatively.The intraoperative consumption of remifentanil and propofol, vasoactive drugs, extubation time, time of PACU stay, time of passing flatus and length of postoperative hospital stay were recorded. Results Compared with group G, the consumption of remifentanil was significantly decreased, the QoR-15 scores were increased at 1-3 days after surgery, the incidence of nausea and vomiting and cognitive decline was decreased, and the extubation time, time of passing flatus and length of postoperative hospital stay were shortened in group TG and group EG (P<0.05). Compared with group TG, the intraoperative requirement for vasoactive drugs was significantly increased in group EG (P<0.05). Conclusion TEAS combined with general anesthesia and epidural block combined with general anesthesia have the comparable effect on the recovery of patients undergoing laparoscopic radical resection of colorectal cancer, however, the former one provides more stable hemodynamics during surgery. Key words: Electric stimulation therapy; Anesthesia, epidural; Laparoscopy; Colorectal surgery; Prognosis

Implementation of an enhanced recovery after surgery (ERAS) program following hepato- pancreato-biliary (HPB) surgeries – Our experience

Introduction: Enhanced recovery after surgery (ERAS) program is an evidence based multimodal perioperative framework developed to reduce postoperative stress and accelerate recovery. Pancreatic and hepatobiliary surgery being highly complex procedures, our study aims in evaluating the role of ERAS protocol in these surgeries. Methodology: It is a prospective case study where ERAS protocol has been applied in patients undergoing pancreatic (n = 33) and hepatobiliary (n = 28) surgeries and results were compared with similar established studies. Results: Demographics, preoperative and operative variables have been assessed in both the groups and were compared with similar studies where no significant difference was noted. In pancreatic surgeries, the mean POPH ( postoperative hospital stay) was 8.7 days, only 2 patients had been re-operated and 9 had readmission. Pancreatic fistula was noted in 9 patients while no patients presented with biliary fistula. In hepatobiliary surgeries, the mean POPH was 7.68 days, only 5 patients had readmission. Complications like bile leak and liver failure are noted in only 2 patients. In both the groups there is decrease in flatus time, early removal of surgical drains, nasogastric tube and urinary catheter, early mobilisation and introduction of oral/ feeding jejunostomy feeds. The results were comparable. Discussion: Following ERAS protocols, the length of postoperative stay can be reduced significantly with consistent decrease in readmission and reoperation rates not compromising patient safety together with acceleration in gastrointestinal function in HPB surgeries. Conclusion: The ERAS program implemented in our study was found to be safe and feasible in HPB surgeries in reducing POPH.