Systematic review and meta-analysis of the effects of the perioperative enhanced recovery after surgery concept on the surgical treatment of acute appendicitis in children

Zhang, Anping; Liang, Hao; Chen, Fang‐Fang; Wu, You; Luo, L B; Sun, Siyi

doi:10.21037/tp-21-457

Cited by 9 publications

(10 citation statements)

References 26 publications

(22 reference statements)

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“…Patient compliance has a positive role in the healing process and results in faster recovery 16 . Our findings showed that the first flatus time and hospital stay length were shorter than those of the control group, which is consistent with the findings of previous studies, 17–20 thus demonstrating that the time to first anal flatus and postoperative in-hospital time were significantly shorter than those of the control group ( P < 0.001).…”

Section: Discussionsupporting

confidence: 91%

The Impact of Regular Diet Recovery on Postoperative Rehabilitation After Elective Cesarean Section

Hu,

Fei,

Liu

et al. 2024

Maternal Fetal Med

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Objective To determine the role of regular diet recovery after restoration of normal muscle strength of both lower extremities in promoting postoperative recovery in women undergoing elective cesarean section. Methods This was a prospective observational cohort study. Patients who underwent elective cesarean section at Xiangya Hospital, Central South University, from October 2022 to December 2022, were categorized into two groups based on the duration of postoperative fasting: the observation group resumed eating after regaining lower extremity muscle strength, while the control group adhered to traditional postoperative fasting guidelines, waiting 6 hours before eating. Primary outcomes included postoperative pain levels assessed by visual analog scale (VAS) pain scores and time to first flatus. Demographic characteristics, time to first lactation, hospital stay length, and patient satisfaction were also assessed. Statistical analysis was conducted using Student’s t test and chi-square test, with significance set at P < 0.05. Results Out of a total of 300 patients, 240 were included in the analysis, comprising 112 in the control group and 128 in the observation group. There were no significant differences in baseline demographic characteristics. The median values of the first flatus time and the first lactation time were 33.37 ± 1.22 vs. 18.06 ± 6.34 hours (P = 0.003) and 26.34 ± 8.21 vs. 7.05 ± 1.26 hours (P = 0.001) in the control and observation groups, respectively. The median hospital stay duration in the control and observation groups was 6.54 ± 0.53 vs. 4.84 ± 0.18 days (P = 0.000), respectively. Median postoperative VAS pain scores and patient satisfaction values were 8.57 ± 0.11 vs. 4.91 ± 0.27 (P = 0.000) and 9.36 ± 0.16 vs. 9.72 ± 0.08 (P = 0.005) in the control and observation groups, respectively. There were no statistically significant differences in other postoperative outcomes, such as intestinal obstruction, infection, and readmission within 42 days (P > 0.05). Conclusion Food intake after restoration of lower extremity muscle strength improves first flatus, relieves postoperative pain, shortens hospital stay, and enhances satisfaction after elective cesarean section, without adverse effects. It is crucial for postoperative rehabilitation and should be encouraged.

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Section: Discussionsupporting

confidence: 91%

The Impact of Regular Diet Recovery on Postoperative Rehabilitation After Elective Cesarean Section

Hu,

Fei,

Liu

et al. 2024

Maternal Fetal Med

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“…Una vez realizado el ajuste correspondiente a la terapia de fluidos, el metamizol siguió estando significativamente asociado con un mayor número de episodios eméticos (p= 0,03), pero no con una mayor proporción de náuseas (p= 0,38). La estancia hospitalaria media fue de 3,86 (3,88) días en el grupo 1 y de 3,75 (3,44) días en el grupo 2 (p= 0,99). En las primeras 24 horas tras la cirugía, 1 paciente de cada grupo recibió el alta gracias a su mejoría clínica.…”

Section: Tabla Iunclassified

“…Tradicionalmente, la mayor parte de las investigaciones sobre la AAP se han centrado en aspectos diagnósticos como el desarrollo de rutas diagnósticas estandarizadas o el empleo de ratios derivados del hemograma como herramientas diagnósticas (1,2) , pero en los últimos años ha surgido un interés cada vez mayor por los aspectos quirúrgicos y postquirúrgicos. Estudios recientes diseñados para analizar los protocolos abreviados han demostrado que estos últimos son seguros y aplicables, reduciendo significativamente la estancia hospitalaria y sus costes económicos y sanitarios asociados (3,4) , mientras que otros estudios se han centrado en identificar la técnica quirúrgica con la evolución postoperatoria más favorable y el período de recuperación más corto. En este sentido, la evidencia revela que las técnicas laparoscópicas son preferibles a las abiertas (5) , habiéndose demostrado que la apendectomía transumbilical por un solo puerto es segura y económica, con buenos resultados postoperatorios en el contexto de la PAA (6) .…”

Section: Introductionunclassified

Evaluación prospectiva del perfil emético y la eficacia analgésica del ibuprofeno y el metamizol intravenosos en el postoperatorio inmediato de la apéndicitis aguda pediátrica

Arredondo Montero,

Antona,

Murillo Jaso

et al. 2024

Cir Pediatr

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ResumenIntroducción. En la literatura existen pocas referencias que comparen las distintas alternativas disponibles para controlar el dolor en el postoperatorio inmediato de la apendicitis aguda pediátrica (AAP).Material y métodos. Comparación prospectiva del perfil analgésico y emético del ibuprofeno y el metamizol intravenosos en el postoperatorio inmediato de la AAP, para lo cual se recurre a una muestra de pacientes operados en 2021 en nuestro centro. Los participantes fueron reclutados a su llegada a Urgencias, obteniéndose confirmación histopatológica del diagnóstico en todos ellos. La evaluación del dolor se llevó a cabo cada 8 horas tras la cirugía mediante escalas analógicas visuales validadas, con valoraciones entre los 0 y los 10 puntos. Se realizó un ANOVA de las medidas repetidas entre los dos grupos para comparar la evolución del dolor en las 48 horas posteriores a la cirugía.Resultados. La muestra estaba compuesta por un total de 95 pacientes (65% de ellos varones) con una edad media de 9,7 años (DT: 3,14). 41 pacientes fueron tratados con ibuprofeno (grupo 1) y 54 con metamizol (grupo 2). No se hallaron diferencias significativas en lo que respecta al dolor, ni en las comparaciones de las mediciones puntuales, ni en su evolución en las 48 horas posteriores a la cirugía (p= 0,58). Una vez realizado el ajuste correspondiente a la terapia de fluidos recibida, los niños del grupo metamizol tuvieron significativamente más episodios eméticos y necesitaron significativamente más dosis de ondansetrón.Conclusiones. En nuestra cohorte, el ibuprofeno tuvo una eficacia analgésica similar y un mejor perfil emético que el metamizol en el postoperatorio inmediato de la AAP. Se hacen necesarios nuevos estudios prospectivos, adecuadamente controlados y con mayor tamaño muestral que validen estos hallazgos.

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“…With the opioid epidemic posing a significant threat, approaches like the opioid-free anaesthesia (OFA) [1] and multimodal general anaesthesia (MMA) [2] are gaining traction. These strategies aim to prevent opioid addiction and chronic postoperative pain, aligning with the goals of the Enhanced Recovery After Surgery (ERAS) protocols [3,4,5 ▪ ,6]. Thus, anaesthesiologists increasingly focus on preoperative, intraoperative, and postoperative analgesia to address factors contributing to chronic postoperative pain.…”

Section: Introductionmentioning

confidence: 99%

The nuts and bolts of multimodal anaesthesia in the 21st century: a primer for clinicians

Lersch,

Correia,

Hight

et al. 2023

Current Opinion in Anaesthesiology

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Purpose of review This review article explores the application of multimodal anaesthesia in general anaesthesia, particularly in conjunction with locoregional anaesthesia, specifically focusing on the importance of EEG monitoring. We provide an evidence-based guide for implementing multimodal anaesthesia, encompassing drug combinations, dosages, and EEG monitoring techniques, to ensure reliable intraoperative anaesthesia while minimizing adverse effects and improving patient outcomes. Recent findings Opioid-free and multimodal general anaesthesia have significantly reduced opioid addiction and chronic postoperative pain. However, the evidence supporting the effectiveness of these approaches is limited. This review attempts to integrate research from broader neuroscientific fields to generate new clinical hypotheses. It discusses the correlation between high-dose intraoperative opioids and increased postoperative opioid consumption and their impact on pain indices and readmission rates. Additionally, it explores the relationship between multimodal anaesthesia and pain processing models and investigates the potential effects of nonpharmacological interventions on preoperative anxiety and postoperative pain. Summary The integration of EEG monitoring is crucial for guiding adequate multimodal anaesthesia and preventing excessive anaesthesia dosing. Furthermore, the review investigates the impact of combining regional and opioid-sparing general anaesthesia on perioperative EEG readings and anaesthetic depth. The findings have significant implications for clinical practice in optimizing multimodal anaesthesia techniques (Supplementary Digital Content 1: Video Abstract, http://links.lww.com/COAN/A96).

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Systematic review and meta-analysis of the effects of the perioperative enhanced recovery after surgery concept on the surgical treatment of acute appendicitis in children

Cited by 9 publications

References 26 publications

The Impact of Regular Diet Recovery on Postoperative Rehabilitation After Elective Cesarean Section

The Impact of Regular Diet Recovery on Postoperative Rehabilitation After Elective Cesarean Section

Evaluación prospectiva del perfil emético y la eficacia analgésica del ibuprofeno y el metamizol intravenosos en el postoperatorio inmediato de la apéndicitis aguda pediátrica

The nuts and bolts of multimodal anaesthesia in the 21st century: a primer for clinicians

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