Working towards an ERAS Protocol for Pancreatic Transplantation: A Narrative Review

Elango, Madhivanan; Papalois, Vassilios

doi:10.3390/jcm10071418

Cited by 6 publications

(7 citation statements)

References 230 publications

(274 reference statements)

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“…[2][3][4] The low return-to-theatre rate from this service evaluation could be attributed to the better recipient and donor selections, organ preservation, back-table preparation, graft placement, and exocrine drainage techniques. 5 The gradual fall in critical care LOS of patients was likely a reflection of the application of the enhanced recovery principles and iCOUGH (incentive spirometry, coughing, oral hygiene, understanding, getting out of bed, head-of-bed elevation) to patients following major surgery. 6 The 4-year data suggested that most patients were either extubated or nearly ready for extubation by the time of their critical care admission.…”

Section: Discussionmentioning

confidence: 99%

Critical Care Length of Stay and Support Requirements for Patients Postpancreas Transplant

Hanison

2023

Prog Transpl

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Introduction: Pancreas transplant is one of the UK’s less commonly done solid abdominal organ transplants. The transplant is reputed for its high-risk postsurgical complications due to multiple patients, procedures, and immunological factors. For this reason, patients are habitually admitted to the intensive care unit for postlaparotomy care, physiological support, and graft function monitoring during their immediate postoperative course. Project Aim: This program evaluation analyzed the trend in critical care length of stay and organ support requirements for patients following whole pancreas transplantation. The aim was to use these baseline data as performance metrics to enable a safer transition and Plan-Do-Study-Act (PDSA) cycles in improving the delivery of enhanced recovery service. Design: A retrospective chart review was performed using records from Phillips IntelliSpace Critical Care and Anaesthesia system to evaluate the institutional outcomes of patients < 18 years admitted to intensive care following pancreas transplantation between January 1, 2018, and December 31, 2021. Islet-cell transplant recipients were excluded as there is a different postoperative recovery. Results: The data suggested that although patients require a higher level of observations, blood pressure management, blood gas, and glucose monitoring during their first week of transplant, these patients did not routinely require the full range of critical care support. Conclusion: The present evaluation reported the organ support requirements for these transplant recipients. The results will generate further interest in enhanced recovery and service evaluation projects to streamline the postoperative care of these patients from the operating theatre back to the transplant wards.

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Section: Discussionmentioning

confidence: 99%

Critical Care Length of Stay and Support Requirements for Patients Postpancreas Transplant

Hanison

2023

Prog Transpl

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“…They recommend against excess fluid administration, 14 although there is no evidence to support the use of restricted fluid regimens such as goal-directed fluid therapy. 10 As with the general surgical population, avoiding nasogastric tube placement in pancreatic transplant recipients resulted in a decreased hospital length of stay without resulting in other complications. 15 Postoperatively, early resumption of enteral nutrition is recommended.…”

Section: Pancreas Transplantation (Table 1)mentioning

confidence: 99%

“…Elango and Papalois published a review outlining an ERAS protocol for patients undergoing pancreas transplantation. 10 Preoperatively, they stressed the importance of (1) prehabilitation, including weight loss and smoking cessation, (2) coagulation testing using thromboelastography, and (3) evaluation of iliac arterial calcification with non-contrast computed tomography scan. Intraoperatively, they discussed a standardized antibiotic protocol with a first-generation cephalosporin for 96 hours and a single dose of an antifungal medication.…”

Section: Pancreas Transplantation (Table 1)mentioning

confidence: 99%

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Abdominal Organ Transplantation: Noteworthy Literature in 2021

Jules

Blech

Sakai

2022

Semin Cardiothorac Vasc Anesth

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This review highlights noteworthy literature pertinent to anesthesiologists and critical care physicians caring for patients undergoing abdominal organ transplantation. In 2021, we identified noteworthy papers from over 1,200 peer-reviewed publications on pancreatic transplantation, over 1,400 on intestinal transplantation, and over 9,000 on kidney transplantation. The liver transplantation section focuses on clinical trials and systematic reviews and meta-analyses published in 2021 and features 20 selected papers. COVID-19 and abdominal organ transplantation are featured in an independent section.

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“…The implementation of enhanced recovery after surgery (ERAS) protocols have improved post‐operative pain management by incorporating a multimodal, multidisciplinary approach. Patient education, utilization of multiple analgesics, and thoughtful discharge planning have all been demonstrated to reduce opioid use while achieving adequate post‐operative pain control 1–4 . While opioid reduction is not the primary goal of ERAS protocols, limiting opioid use and prescribing has both societal and individual patient benefits 5–7 …”

Section: Introductionmentioning

confidence: 99%

Evaluation of a multidisciplinary, multimodal pain management protocol following pancreas transplantation

Lindner

Lakhani

Cooper

et al. 2022

Clinical Transplantation

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Introduction: Patients undergoing solid-organ transplantation demonstrate pain arising from both the surgical intervention and pre-existing comorbidities. High levels of opioid use both pre-and post-transplant are associated with unfavorable transplant outcomes. Patient education, multimodal therapy, and discharge planning have all been demonstrated to reduce opioid use after transplant.Methods: This is a single-center, retrospective study analyzing patients before and after implementation of a multimodal, multidisciplinary pain management protocol.Morphine milligram equivalents (MMEs) use during the index transplant hospitalization and the need for opioids at discharge was compared between the pre-and post-protocol groups.Results: A total of 52 patients were included in the study, 31 in the pre and 21 in the post-protocol groups. Inpatient MME use was reduced from 135.5 to 67.5 MMEs after protocol implementation. Additionally, the number of patients discharged on opioids following transplant decreased from 90.3% to 47.6%. Pain scores, length of stay (LOS), and return of bowel function was not different between groups. Conclusion:The implementation of a multimodal, multidisciplinary pain management protocol significantly decreased opioid use during the post-surgical hospitalization and in the 6 months following transplantation. A combination of non-opioid analgesics, patient education, and discharge planning can be beneficial elements in pancreas transplant pain management.

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Working towards an ERAS Protocol for Pancreatic Transplantation: A Narrative Review

Cited by 6 publications

References 230 publications

Critical Care Length of Stay and Support Requirements for Patients Postpancreas Transplant

Critical Care Length of Stay and Support Requirements for Patients Postpancreas Transplant

Abdominal Organ Transplantation: Noteworthy Literature in 2021

Evaluation of a multidisciplinary, multimodal pain management protocol following pancreas transplantation

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