DOI: https://doi.org/10.22141/2224-0586.6.85.2017.111608

Elements of the fast-track concept in the postoperative treatment of colorectal cancer

A.A. Zavhorodnii, S.N. Gritsenko

Abstract


The introduction of new approaches for more complex elective surgical interventions has led to the emergence of the concept of fast-track surgery (the concept of rapid recovery). The fast-track concept has caused a high medical interest. The authors concluded that the use of a multimodal approach in older patients at high risk shortens hospital stay and reduces the number of postoperative complications. A recovery strategy provides an effective analgesia, early mobility, early enteral rehydration and nutrition. 102 patients with tumors of the large intestine were examined. Patients after surgery were admitted to the intensive care unit. Control group (n = 53) was anesthetized with non-steroidal anti-inflammatory drugs together with opiates. The study group (n = 49) received extended continuous epidural analgesia as a part of multimodal analgesia. Monitoring was performed for pain level on a visual analogue scale, time of appearance of peristalsis and the start of tube feeding, as well as the duration of stay in the intensive care unit. The pain intensity in the control group has significantly increased (by 98 %) compared to the study group (p = 0.00954). In the control group, patients subjectively assessed pain of varying intensity at rest, while in the study group, patients already on the 3rd day of the early postoperative period reported mild pain only during active movement in bed. Earlier recovery of peristalsis and the start of tube feeding in patients were noted in the study group. Ringer solution into the probe was introduced in the first day, and tube feeding patients received on the second day after surgery, and the time of stay in the intensive care unit decreased by 28 %. At the same time, in the control group, where patients were anesthetized with dexketoprofen 150 mg/day along with opiates, peristalsis appeared only on the third day after surgery. Enteral nutrition was started only on the third day.


Keywords


extended prolonged epidural analgesia; fast-track concept; peristalsis; tube feeding; colorectal cancer

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