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 .
Superior functional outcome after radical cystectomy and orthotopic bladder substitution with restrictive intraoperative fluid management: a followup study of a randomized clinical trial.
PURPOSE Continuous intraoperative norepinephrine infusion combined with restrictive deferred hydration improves surgical field visibility , and significantly decreases intraoperative blood loss and postoperative complications in patients undergoing radical cystectomy and urinary diversion . We determined whether the intraoperative fluid regimen would affect functional results ( continence and erectile function ) 1 year after orthotopic ileal bladder substitution . MATERIAL S AND METHODS We analyzed a subgroup of 93 patients who received an ileal orthotopic bladder substitute .  The subgroup was part of a r and omized trial in 167 patients initially allocated to continuous norepinephrine administration starting with 2 μg/kg per hour combined with 1 ml/kg per hour initially and 3 ml/kg per hour crystalloid infusion after cystectomy ( norepinephrine/low volume group of 51 ) or a st and ard crystalloid infusion of 6 ml/kg per hour throughout surgery ( 42 controls ) . We prospect ively assessed daytime and nighttime continence , and erectile function 1 year postoperatively in the 93-patient subgroup . RESULTS Daytime continence was reported by 44 of 51 patients ( 86 % ) in the norepinephrine/low volume group and by 27 of 42 controls ( 64 % ) ( p = 0.016 ) , and nighttime continence was reported by 38 ( 75 % ) and 25 ( 60 % ) , respectively ( p = 0.077 ) . Erectile function recovery was reported by 26 of 33 preoperatively potent patients ( 79 % ) in the norepinephrine/low volume group and by 11 of 29 controls ( 38 % ) ( p = 0.002 ) . CONCLUSIONS Patients who undergo radical cystectomy and orthotopic bladder substitution  with continuous norepinephrine infusion and restrictive hydration during surgery have significantly better daytime continence and erectile function 1 year postoperatively
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 .