Enhanced Recovery via Peripheral Nerve Block for Open Hepatectomy

Thornblade, Lucas W.; Seo, Yongwoo David; Kwan, Tracy; Cardoso, Jane H; Pan, Eric; Dembo, Gregory; Yeung, Raymond S.; Park, James O.

doi:10.1007/s11605-017-3656-y

Cited by 18 publications

(12 citation statements)

References 28 publications

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“…30 Using a method suggested by Furukawa et al, 44 standard deviation was borrowed from a study with similar sample size and mean. 41 Pooling of all results revealed a lower hospital cost in ERAS group compared to standard care (SMD = −0.98; CI, −1.37 to -0.58; p < 0.0001). However, there was a significant heterogeneity observed among all studies (χ 2 = 109.63; df = 9; p < 0.0001; I 2 = 92%).…”

Section: Hospital Costmentioning

confidence: 89%

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Enhanced Recovery After Surgery (ERAS) Reduces Hospital Costs and Improve Clinical Outcomes in Liver Surgery: a Systematic Review and Meta-Analysis

Noba

Rodgers

Chandler

et al. 2020

Journal of Gastrointestinal Surgery

152

101

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Background Enhanced recovery after surgery (ERAS) protocols are evidence-based, multimodal and patient-centred approach to optimize patient care and experience during their perioperative pathway. It has been shown to be effective in reducing length of hospital stay and improving clinical outcomes. However, evidence on its effective in liver surgery remains weak. The aim of this review is to investigate clinical benefits, cost-effectiveness and compliance to ERAS protocols in liver surgery. Methods A systematic literature search was conducted using CINAHL Plus, EMBASE, MEDLINE, PubMed and Cochrane for randomized control trials (RCTs) and cohort studies published between 2008 and 2019, comparing effect of ERAS protocols and standard care on hospital cost, LOS, complications, readmission, mortality and compliance. Results The search resulted in 6 RCTs and 21 cohort studies of 3739 patients (1777 in ERAS and 1962 in standard care group). LOS was reduced by 2.22 days in ERAS group (MD = −2.22; CI, −2.77 to −1.68; p < 0.00001) compared to the standard care group. Fewer patients in ERAS group experienced complications (RR, 0.71; 95% CI, 0.65-0.77; p = < 0.00001). Hospital cost was significantly lower in the ERAS group (SMD = −0.98; CI, −1.37 to-0.58; p < 0.0001). Conclusion Our review concluded that the introduction of ERAS protocols is safe and feasible in hepatectomies, without increasing mortality and readmission rates, whilst reducing LOS and risk of complications, and with a significant hospital cost savings. Laparoscopic approach may be necessary to reduce complication rates in liver surgery. However, further studies are needed to investigate overall compliance to ERAS protocols and its impact on clinical outcomes.

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Section: Hospital Costmentioning

confidence: 89%

“…Five of the studies reported hospital cost in US dollar, 21,22,29,35,41 three in Chinese yuan 28,30,42 and two in euros. 24,33 One study reported 30% reduction in hospital cost in ERAS group without providing further data, 36 and one did not provide data on overall hospital cost.…”

Section: Hospital Costmentioning

confidence: 99%

Enhanced Recovery After Surgery (ERAS) Reduces Hospital Costs and Improve Clinical Outcomes in Liver Surgery: a Systematic Review and Meta-Analysis

Noba

Rodgers

Chandler

et al. 2020

Journal of Gastrointestinal Surgery

152

101

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“…It has fewer adverse effects and did not affect gastrointestinal motility. ERAS guidelines for many disciplines have recommended the regional block techniques as adjuvant analgesia during the perioperative period [8, 25], which can significantly reduce the use of opioid analgesics. Appropriate regional block techniques can completely replace opioids.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound guided continuous Quadratus Lumborum block hastened recovery in patients undergoing open liver resection: a randomized controlled, open-label trial

Zhu

Yang

et al. 2019

BMC Anesthesiol

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Background Quadratus lumborum (QL) block is increasingly being used as a new abdominal nerve block technique. In some studies of mid and lower abdominal and hip analgesia, continuous QL block achieved favorable outcomes as an alternative to continuous intravenous analgesia with opioids. However, the use of continuous QL block for upper abdominal pain is less well characterized. This study aimed to investigate the effects of continuous anterior QL block (CQLB) on postoperative pain and recovery in patients undergoing open liver resection. Methods Sixty-three patients underwent elective open liver resection were randomly divided into continuous anterior QL block (CQLB, n = 32) group and patient-controlled intravenous analgesia (PCIA, n = 31) group. Patients in CQLB group underwent ultrasound-guided anterior QL block at the second lumbar vertebral transverse processes before general anesthesia, followed by postoperative CQLB analgesia. Patients in PCIA group underwent continuous intravenous analgesia postoperatively. Postoperative numerical rating scale (NRS) pain scores upon coughing and at rest, self-administered analgesic counts, rate of rescue analgesic use, time to first out-of-bed activity and anal flatus after surgery, and incidences of analgesic-related adverse effects were recorded. Results Postoperative NRS pain scores on coughing in CQLB group at different time points and NRS pain score at rest 48 h after surgery were significantly lower than those in PCIA group ( P < 0.05). Time to first out-of-bed activity and anal flatus after surgery in CQLB group were significantly earlier than those in PCIA group ( P < 0.05). No significant differences of postoperative self-administered analgesic counts, rate of postoperative rescue analgesic usage, or incidences of analgesic-related adverse effects were found between the two groups ( P > 0.05). Conclusions Ultrasound-guided anterior QL block significantly alleviated the pain during coughing after surgery, shortened the time to first out-of-bed activity and anal flatus, promoting postoperative recovery of the patients undergoing open liver resection. Trial registration This study has been registered in April 1, 2018 on Chinese Clinical Trail Registry, the registration number is ChiCTR1800015454 .

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“…This has prompted us to re-evaluate and limit our use of gabapentinoids in the preoperative and perioperative period, particularly at higher doses. Local anesthetic nerve blocks are another cornerstone of ERAS pathways designed to provide immediate perioperative and postoperative pain relief (32)(33)(34). However, standard local anesthetics such as the lidocaine/bupivacaine mixture used by Lucas et al have a relatively limited duration of action, thereby compromising their ability to provide prolonged pain relief beyond the first several hours postoperatively (13,14).…”

Section: Discussionmentioning

confidence: 99%

Long-acting liposomal bupivacaine and postoperative opioid use after Peyronie’s disease surgery: a pilot study

Britton¹,

Findlay²,

Parikh³

et al. 2021

Transl Androl Urol

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Background: Novel strategies have been proposed to minimize postoperative opioid use, yet many patients experience significant pain after penile surgery. Our objective was to evaluate postoperative opioid use in patients undergoing penile ring block with long-acting liposomal bupivacaine (LB; Exparel) during surgery for Peyronie's disease (PD). Methods: We identified patients who underwent tunica albuginea plication (TAP) and plaque excision/ grafting (PEG) for PD between July 2019 and September 2020. Intraoperatively, a ring block was administered at the penile base penis with 20 cc of LB. Patients were instructed to use over the counter pain medications as first line treatment for postoperative pain, and opioids were available for severe breakthrough pain as needed [7.5 oral morphine equivalents (OME) =5 mg oxycodone]. Opioid use was assessed during the first five days postoperatively.Results: In total, 28 patients met inclusion criteria including 18/28 (64%) who underwent TAP and 10/28 (36%) who underwent PEG. Median patient age was 56 years (IGR 51;61). Median postoperative 10-point visual analogue pain score was 0 (range 0-3). Duration of penile anesthesia ranged from 1.5-4 days. In total, 9/28 patients (32%) utilized opioids during the first five days postoperatively (range 7.5-75 OME). Two patients (7%) required opioids during the first two days after surgery. 27/28 (96%) were satisfied or highly satisfied with postoperative pain control.Conclusions: Intraoperative penile ring block with LB resulted in excellent pain control with local anesthetic duration of 1.5-4 days. The majority of patients did not require any opioids during the early postoperative period. Further study comparing outcomes with shorter-acting local anesthetics is necessary to balance pain control benefits with additional cost.

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Enhanced Recovery via Peripheral Nerve Block for Open Hepatectomy

Abstract: The use of TAP block for hepatectomy as part of an ERAS protocol is associated with improved quality and cost of care. Surgeons performing liver resections should consider standardization of evidence-based best practices in all patients.

Cited by 18 publications

References 28 publications

Enhanced Recovery After Surgery (ERAS) Reduces Hospital Costs and Improve Clinical Outcomes in Liver Surgery: a Systematic Review and Meta-Analysis

Enhanced Recovery After Surgery (ERAS) Reduces Hospital Costs and Improve Clinical Outcomes in Liver Surgery: a Systematic Review and Meta-Analysis

Ultrasound guided continuous Quadratus Lumborum block hastened recovery in patients undergoing open liver resection: a randomized controlled, open-label trial

Long-acting liposomal bupivacaine and postoperative opioid use after Peyronie’s disease surgery: a pilot study

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