Outcomes after implementation of a multimodal standard care pathway for laparoscopic colorectal surgery

Larson, David W.; Lovely, Jenna K.; Cima, Robert R.; Dozois, Eric J.; Chua, Heidi K; Wolff, Bruce G.; Pembérton, John H.; Devine, Rita; Huebner, Marianne

doi:10.1002/bjs.9534

Cited by 121 publications

(89 citation statements)

References 43 publications

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“…Multimodal pain regimens that include gabapentin, NSAIDs, acetaminophen, and regional anesthesia were effective in controlling perioperative pain and decreasing perioperative opioid use following arthroplasty surgery [74,75]. The literature has highlighted the need for studies focused on multimodal analgesic protocols for colorectal [76], thoracic, amputation, mastectomy [77], orthopaedic [37], and liver resection surgeries [65]. In these trials, the outcome of interest should not only focus on reducing acute postoperative pain and opioid consumption (due to the immediate drug effect), but also on ascertaining whether preventive effects that reduce the incidence and severity of CPSP are demonstrated.…”

Section: Multimodal Analgesiamentioning

confidence: 99%

Preventive Analgesia and Novel Strategies for the Prevention of Chronic Post-Surgical Pain

Clarke

Poon

Weinrib

et al. 2015

Drugs

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Chronic post-surgical pain (CPSP) is a serious complication of major surgery that can impair a patient's quality of life. The development of CPSP is a complex process which involves biologic, psychosocial, and environmental mechanisms that have yet to be fully understood. Currently perioperative pharmacologic interventions aim to suppress and prevent sensitization with the aim of reducing pain and analgesic requirement in acute as well as long-term pain . Despite the detrimental effects of CPSP on patients, the body of literature focused on treatment strategies to reduce CPSP remains limited and continues to be understudied. This article reviews the main pharmacologic candidates for the treatment of CPSP, discusses the future of preventive analgesia, and considers novel strategies to help treat acute postoperative pain and lessen the risk that it becomes chronic. In addition, this article highlights important areas of focus for clinical practice including: multimodal management of CPSP patients, psychological modifiers of the pain experience, and the development of a Transitional Pain Service specifically designed to manage patients at high risk of developing chronic post-surgical pain. Key PointsThe development of chronic post-surgical pain (CPSP) is a complex process which involves biologic, psychosocial, and environmental mechanisms.Ketamine (an NMDA antagonist) appears to be the pharmacologic agent with the most consistent positive preventive analgesic results.The variation in patient response to pharmacologic agents can be explained, in part, by genetic polymorphisms.Understanding the heritability of CPSP will be useful when developing predictive algorithms to determine the preoperative risk for developing CPSP.Psychological treatments delivered before and after surgery have the potential to influence the trajectory of CPSP from the earliest days, in combination with multimodal, preventive analgesia.

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Section: Multimodal Analgesiamentioning

confidence: 99%

Preventive Analgesia and Novel Strategies for the Prevention of Chronic Post-Surgical Pain

Clarke

Poon

Weinrib

et al. 2015

Drugs

View full text Add to dashboard Cite

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“…Mathiesen et al demonstrated significantly reduced opioid consumption and associated side effects as well as improved postoperative mobilization in patients undergoing multilevel spine surgery following the implementation of a comprehensive multimodal treatment paradigm [73]. Similar findings have also been reported in the general surgery literature [74][75][76].…”

Section: Proxies For Measuring Pain Management Resultsmentioning

confidence: 53%

Best evidence in multimodal pain management in spine surgery and means of assessing postoperative pain and functional outcomes

Devin

McGirt

2015

Journal of Clinical Neuroscience

197

133

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“…Multimodal analgesia has been successfully implemented into multiple surgical pathways, and has been shown to reduce opioid consumption (38), surgical complications (38,39), and length of hospital stay (38,39,40). Some agents that have been used successfully in multimodal pathways include acetaminophen (PO and IV), cyclooxygenase-2 (COX-2) inhibitors, gabapentinoids (gabapentin and pregabalin), non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, local anesthetics, α-2 agonists (clonidine and dexmedetomidine), and ketamine (Table 3).…”

Section: Multimodal Approach To Postoperative Analgesiamentioning

confidence: 99%

Managing Opioid-Tolerant Patients in the Perioperative Surgical Home

Wenzel

Schwenk

Baratta

et al. 2016

Anesthesiology Clinics

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Outcomes after implementation of a multimodal standard care pathway for laparoscopic colorectal surgery

Abstract: Compliance with an enhanced recovery pathway was associated with less opiate use, fewer complications and a shorter hospital stay.

Cited by 121 publications

References 43 publications

Preventive Analgesia and Novel Strategies for the Prevention of Chronic Post-Surgical Pain

Preventive Analgesia and Novel Strategies for the Prevention of Chronic Post-Surgical Pain

Best evidence in multimodal pain management in spine surgery and means of assessing postoperative pain and functional outcomes

Managing Opioid-Tolerant Patients in the Perioperative Surgical Home

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