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 .
The Analgesic Efficacy of Transversus Abdominis Plane Block After Abdominal Surgery: A Prospective Randomized Controlled Trial
BACKGROUND : The transversus abdominis plane ( TAP ) block is a novel approach for blocking the abdominal wall neural afferents via the bilateral lumbar triangles of Petit . We evaluated its analgesic efficacy in patients during the first 24 postoperative hours after abdominal surgery , in a r and omized , controlled , double-blind clinical trial . METHODS : Thirty-two adults undergoing large bowel resection via a midline abdominal incision were r and omized to receive st and ard care , including patient-controlled morphine analgesia and regular nonsteroidal antiinflammatory drugs and acetaminophen ( n = 16 ) , or to undergo TAP block  ( n = 16 ) in addition to st and ard care ( n = 16 ) . After induction of anesthesia , 20 mL of 0.375 % levobupivacaine was deposited into the transversus abdominis neuro-fascial plane via the bilateral lumbar triangles of Petit . Each patient was assessed by a blinded investigator in the postanesthesia care unit and at 2 , 4 , 6 , and 24 h postoperatively . RESULTS : The TAP block reduced visual analog scale pain scores ( TAP versus control , mean ± sd ) on emergence ( 1 ± 1.4 vs 6.6 ± 2.8 , P < 0.05 ) , and at all postoperative time points , including at 24 h ( 1.7 ± 1.7 vs 3.1 ± 1.5 , P < 0.05 ) . Morphine requirements in the first 24 postoperative hours were also reduced ( 21.9 ± 8.9 mg vs 80.4 ± 19.2 mg , P < 0.05 ) . There were no complications attributable to the TAP block . All TAP patients reported high levels of satisfaction with their postoperative analgesic regimen . CONCLUSIONS : The TAP block provided highly effective postoperative analgesia in the first 24 postoperative hours after major abdominal surgery
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 .