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 .
Comparison of analgesic efficacy of subcostal transversus abdominis plane blocks with epidural analgesia following upper abdominal surgery
Subcostal transversus abdominis plane ( TAP ) catheters have been reported to be an effective method of providing analgesia after upper abdominal surgery . We compared their analgesic efficacy with that of epidural analgesia after major upper abdominal surgery in a r and omised controlled trial . Adult patients undergoing elective open hepatobiliary or renal surgery were r and omly allocated to receive subcostal TAP catheters ( n = 29 ) or epidural analgesia ( n = 33 ) , in addition to a st and ard postoperative analgesic regimen comprising of regular paracetamol and tramadol as required . The TAP group patients received bilateral subcostal TAP catheters and 1 mg.kg−1 bupivacaine 0.375 % bilaterally every 8 h. The epidural group patients received an infusion of bupivacaine 0.125 % with fentanyl 2 μg.ml−1 . The primary outcome measure was visual analogue pain scores during coughing at 8 , 24 , 48 and 72 h after surgery . We found no significant differences in median ( IQR [ range ] ) visual analogue scores during coughing at 8 h between the TAP group ( 4.0 ( 2.3–6.0 [ 0–7.5 ] ) ) and epidural group ( 4.0 ( 2.5–5.3 ) [ 0–8.5 ] ) ) and at 72 h ( 2.0 ( 0.8–4.0 [ 0–5 ] ) and 2.5 ( 1.0–5.0 [ 0–6 ] ) , respectively ) . Tramadol consumption was significantly greater in the TAP group ( p = 0.002 ) . Subcostal TAP catheter boluses may be an effective alternative to epidural infusions for providing postoperative analgesia after upper 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 .