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 .
A new concept for early recovery after surgery for patients undergoing radical cystectomy for bladder cancer: results of a prospective randomized study.
PURPOSE Early recovery after surgery concepts have gained wide acceptance in various surgical specialties . However , limited data are available for radical cystectomy . A new early recovery after surgery concept was compared to a more conservative regimen in patients undergoing radical cystectomy for bladder cancer . MATERIAL S AND METHODS A total of 101 consecutive patients were prospect ively r and omized to early recovery after surgery  ( 62 ) or a conservative regimen  ( 39 ) ( intended r and omization ratio was 2 early recovery after surgery-to-1 conservative regimen ) . Primary end points were differences in quality of life , and secondary end points included postoperative morbidity , dem and for analgesics , time spent in the intermediate care unit , mobility and number of gastrointestinal events during hospital stay . RESULTS Quality of life parameters , as measured by the EORTC ( European Organization for the Research and Treatment of Cancer ) Quality of Life question naire QLQ-30 did not change significantly between postoperative days 3 and 7 and at discharge from hospital in the conservative regimen group , whereas a significant improvement was observed in the early recovery after surgery group . Postoperative morbidity was lower in the early recovery after surgery group in terms of wound healing disorders ( p = 0.006 ) , fever ( p = 0.004 ) and thrombosis ( p = 0.027 ) . The dem and for analgesics was significantly lower in the early recovery after surgery group . The amount of food consumed in relation to the amount of food offered was significantly higher for the early recovery after surgery group as early as day 3 ( p = 0.02 ) . Time spent in the intermediate care unit was significantly shorter for the early recovery after surgery group ( p < 0.001 ) . There were no significant differences between the groups with respect to gastrointestinal events . The main limitations of this study were the lack of long-term data as well as the single center approach . CONCLUSIONS Early recovery after surgery of patients who underwent radical cystectomy appears to have significant benefits compared to a conservative regimen in terms of postoperative morbidity , quality of life , use of analgesics and time spent in the intermediate care unit
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 .