Comparative evaluation of two methods care of the perioperative period after laparoscopic operations on uterine appendages

• Main Authors: О. S. Lashkul, N. S. Lutsenko
• Format: Article
• Language: English
• Published: Zaporozhye State Medical University 2017-10-01
• Series: Zaporožskij Medicinskij Žurnal
• Subjects: FTS; laparoscopy; uterine appendages; perioperative period
• Online Access: http://zmj.zsmu.edu.ua/article/view/110165/107070
• ISSN: 2306-4145; 2310-1210

Aim – тo assess the impact of the early multimodal rehabilitation concept on postoperative period after laparoscopic operations on uterine appendages. Маterials and methods. The study involved 79 patients who were randomized by envelope method in two groups. In the main group (26 patients), a protocol of early multimodal rehabilitation (ERAS) was used. In the control group (53 patients), the traditional perioperative regimen was used. In both groups, laparoscopic operations were performed under general anesthesia with mechanical ventilation (propofol + fentanyl). In perioperative anesthesia NSAIDs (dexketoprofen, ketorolac, paracetamol) were included. Non-invasive monitoring was performed by the «Leon» monitor (StO2, blood pressure, heart rate, capnogram), hourly diuresis was taken into account, thermometry was performed. In the postoperative period analgesia with combination with systemic administration of dexketoprofen (100–150 mg/day) + ketorolac (60 mg/day) + paracetamol (3000 mg/day) was used. Results. The groups were homogeneous according to anamnestic (the beginning of menstruation, the number of pregnancies, childbirth, abortions, miscarriages), anthropometric and demographic characteristics, the duration of operations, blood loss and baseline values of systolic, diastolic, mean arterial pressures and heart rate. In groups the volumes of diuresis did not differ significantly (p < 0.05). Positive intraoperative hemohydrate balance in the FTS group was almost half that in the control group. When assessing pain at rest by VAS, a statistically significant difference was found at the 6 and 24 hours study stages. Nevertheless, at the study stages the pain level in the control group did not exceed 30 mm, which indicates adequate analgesia at rest. The level of cough pain in the control group exceeded the level of pain in the main group, the statistical difference was determined after 6 hours and 24 hours, but was above 30 mm, which required additional administration of analgetics. The urinary and venous catheter, as well as the drainage in the main group, were removed on the first day, in the control group – on the second day. Recovery of peristalsis and the possibility of verticalization of the main group patients occurred earlier than in the patients of the control group. The postoperative patient bed-day of the main group (FTS) patients was half that in the control group without FTS. In groups the volumes of diuresis did not differ significantly (p < 0.05). Positive intraoperative hemohydrate balance in the FTS group was almost half that in the control group. When assessing pain at rest by VAS, a statistically significant difference was found at the 6 and 24 hours study stages. Nevertheless, at the study stages the pain level in the control group did not exceed 30 mm, which indicates adequate analgesia at rest. The level of cough pain in the control group exceeded the level of pain in the main group, the statistical difference was determined after 6 hours and 24 hours, but was above 30 mm, which required additional administration of analgetics. The urinary and venous catheter, as well as the drainage in the main group, were removed on the first day, in the control group – on the second day. Recovery of peristalsis and the possibility of verticalization of the main group patients occurred earlier than in the patients of the control group. The postoperative patient bed-day of the main group (FTS) patients was half that in the control group without FTS. Conclusions. The proposed package of measures is one of the ways to implement the Fast track concept for laparoscopic operations on the uterine appendages. The introduction of the Fast Track surgery concept allowed to achieve a significant reduction in the postoperative bed-day, which undoubtedly has an economic effect and significantly increases the prestige of doctors.