American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) Joint Consensus Statement on Optimal Analgesia within an Enhanced Recovery Pathway for Colorectal Surgery: Part 2—From PACU to the Transition Home

Abstract

BackgroundWithin an enhanced recovery pathway (ERP), the approach to treating pain should be multifaceted and the goal should be to deliver “optimal analgesia”, which we define in this paper as a technique that optimizes patient comfort and facilitates functional recovery with the fewest medication side effects.MethodsWith input from a multidisciplinary, international group of experts and through a structured review of the literature and use of a modified Delphi method, we achieved consensus surrounding the topic of optimal analgesia in the perioperative period for colorectal surgery patients.DiscussionAs a part of the first Perioperative Quality Improvement (POQI) workgroup meeting, we sought to develop a consensus document describing a comprehensive, yet rational and practical, approach for developing an evidence-based plan for achieving optimal analgesia, specifically for a colorectal surgery within an ERP. The goal was twofold: (a) that application of this process would lead to improved patient outcomes and (b) that investigation of the questions raised would identify knowledge gaps to aid the direction for research into analgesia within ERPs in the years to come. This document details the evidence for a wide range of analgesic components, with particular focus on care in the post-anesthesia care unit, general care ward, and transition to home after discharge. The preoperative and operative consensus statement for analgesia was covered in Part 1 of this paper. The overall conclusion is that the combination of analgesic techniques employed in the perioperative period is not important as long as it is effective in delivering the goal of “optimal analgesia” as set forth in this document.

Minimally invasive sigmoidectomy for diverticular disease decreases inpatient opioid use: Results of a propensity score-matched study

“…7 Early oral intake in the immediate postoperative period allows optimization of multimodal pain regimens that include oral non-opioid pain medications, thereby minimizing the need for opioid analgesia. 25,26 Prior studies have shown shorter hospital LOS for MIS compared to open colorectal surgery, and shorter LOS for RS compared to LS groups. 27e30 The shorter LOS for MIS compared to open groups, and RS compared to LS groups, is likely multifactorial, but less parenteral opioids and quicker postoperative transition to oral intake result in earlier return of gastrointestinal activity, less ileus, and earlier discharge.…”

“…Varying protocols may include elements such as acetaminophen, nonsteroidal anti-inflammatory medications, gabapentin, transversus abdominis plane blocks, and intrathecal or epidural analgesia options. 35 The PHD dataset does not identify which institutions had established enhanced recovery pathways with multimodal pain management strategies 25,26 and so the impact of these pathways on decreasing or obviating inpatient opioid use could not be determined in our study. 25,26 However, we implemented a multilevel random-effects regression model to control for hospital-level clustering of opioid prescribing patterns and the results support less inpatient opioid use in MIS patients.…”

“…35 The PHD dataset does not identify which institutions had established enhanced recovery pathways with multimodal pain management strategies 25,26 and so the impact of these pathways on decreasing or obviating inpatient opioid use could not be determined in our study. 25,26 However, we implemented a multilevel random-effects regression model to control for hospital-level clustering of opioid prescribing patterns and the results support less inpatient opioid use in MIS patients. Compared to prior publications 15 limited by sample size and a specific population (colorectal cancer), this study benefits from the use of a large, national database reflecting opioid practice patterns following sigmoid resection from a heterogeneous sample of hospitals and surgeons.…”

Correction to: American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) Joint Consensus Statement on Optimal Analgesia within an Enhanced Recovery Pathway for Colorectal Surgery: Part 2—From PACU to the Transition Home

“…After publication of this article (Scott et al 2017 ), it was noticed that the HTML version contained technical errors regarding the collaborator information of the Perioperative Quality Initiative (POQI) I Workgroup. The Declarations section was missing the acknowledgements for the group.…”

Rhythm and cues: role of chronobiology in perioperative medicine

“…They have driven advancements in intravenous fluid therapy and transformed the landscape of clinical practice through the success of enhanced recovery after surgery (ERAS) programmes. It has been proposed that a rational assessment tool for ERAS would be a succinct patient-related outcome measure, such as whether or not the patient is 'DREAMing' within 24 h of surgery (Drinking, EAting, and Mobilising), 37 a concept recently upgraded to 'DREAMS' 38 by the addition of 'Sleep'. It is an interesting observation that all of these components also happen to be the most important Zeitgebers, and therefore contribute to the preservation of a healthy circadian rhythm.…”