Intraoperatively , a fluid and opioid sparing protocol may reduce fluid shifts and avoid complications from paralytic ileus .
Finally , enhanced recovery protocol s including novel medications , early feeding , and multi-modal analgesia approaches are associated with earlier postoperative convalescence .
CONCLUSION RC is a complex and morbid procedure that may benefit from care re design .
OBJECTIVE To present an evidence -based review of the perioperative management of the radical cystectomy ( RC ) patient in the context of a care re design initiative .
Epidural versus Continuous Transversus Abdominis Plane Catheter Technique for Postoperative Analgesia after Abdominal Surgery
Transversus abdominis plane block is an effective postoperative analgesic technique after abdominal surgery , but no study has compared continuous transversus abdominis plane block with continuous epidural analgesia . We design ed a r and omised controlled trial comparing these techniques for major abdominal surgery . Patients in the epidural group received a bolus of 8 to 15 ml of ropivacaine 0.2 % and an infusion of 5 to 15 ml/hour and the transversus abdominis plane block group a bolus dose of 20 ml of ropivacaine 0.375 % bilaterally and an infusion of 0.2 % ropivacaine 8 ml/hour bilaterally , for three days . Both groups received paracetamol and patient controlled analgesia with fentanyl for three days . Primary outcomes were numerical rating scores for pain ( rest and dynamic over 72 hours ) and total fentanyl use ; complications and satisfaction scores were also noted . The study was terminated early after 42 patients had been r and omised ( epidural n=19 ; transversus abdominis plane block n=22 ; one excluded ) . No differences were found in regards to point pain scores or scores over time , either immediately postoperatively or in surgical wards ; total fentanyl requirement and Likert satisfaction scores were also similar in both groups . In this underpowered study we found comparable results between continuous transversus abdominis plane technique and epidural analgesia in regard to pain , analgesic use and satisfaction after abdominal surgery . To confirm this finding , r and omised trials with larger numbers of participants are needed
Intraoperatively , a fluid and opioid sparing protocol may reduce fluid shifts and avoid complications from paralytic ileus .
Finally , enhanced recovery protocol s including novel medications , early feeding , and multi-modal analgesia approaches are associated with earlier postoperative convalescence .
CONCLUSION RC is a complex and morbid procedure that may benefit from care re design .
OBJECTIVE To present an evidence -based review of the perioperative management of the radical cystectomy ( RC ) patient in the context of a care re design initiative .