Enhanced recovery after surgery multimodality pain regimen performs similar to PRN narcotics on outcomes and pain control after cardiac surgery: A quality improvement project.

BACKGROUND: While enhanced recovery after surgery (ERAS) pathways have been successfully applied for cardiac surgery, there has been limited research directly comparing ERAS protocols to ad hoc narcotic use after surgery. We hypothesized that a standardized ERAS protocol would provide similar pain management and psychoemotional outcomes while decreasing the use of opioids in the hospital and after discharge. METHODS: As part of a 7-month quality improvement project, cardiac surgery patients on a fast-tracked to extubate pathway were assigned pro re nata (PRN) narcotic pain management for 3 months (n = 49). After a 1-month ERAS protocol optimization period, a separate group of patients were given the ERAS protocol (n = 34). Clinical outcomes were gathered, and participants completed a quality of recovery survey that allowed for the assessment of pain and symptom control at four-time points after surgery. RESULTS: Among 83 participants, 66% were male and the mean age was 53 years. There were no differences in patient characteristics between PRN and ERAS groups (all p > .244). There were no differences between ERAS and PRN groups for surgery characteristics (all p > .060), inpatient outcomes (all p > .658), or after-discharge outcomes (all p > .397). Furthermore, across all time-point comparisons, there were no supported differences in patient-reported outcome and pain control between the ERAS and PRN narcotic groups (all p > .075). CONCLUSIONS: An ERAS protocol demonstrated similar patient outcomes and pain control to traditional opioid use for postoperative cardiac surgery patients. Further research is recommended to further confirm the results of this study.

Omega-3 fatty acids and cardiovascular risk.

BACKGROUND: Omega-3 polyunsaturated fatty acids (PUFA's) have an FDA indication for triglyceride lowering in patients with hypertriglyceridemia. Some European agencies have also approved omega-3 fatty acids for cardiovascular risk modification. Several major societies in the US also recommend their use following myocardial infarction. OBJECTIVE: The purpose of this review was to assimilate available evidence from randomized controlled trials into one systematic review to determine the association between omega-3 fatty acids and cardiovascular outcomes. DESIGN: Systematic review of randomized, controlled trials with meta-analysis METHODS: PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (up to August 2012) were searched using a predefined algorithm. All randomized trials evaluating omega-3 polyunsaturated fatty acid supplementation in adults were considered. Trials selected were all randomized, controlled against another diet or placebo, and implemented in primary or secondary cardiovascular disease (CVD) prevention settings. Trials with duration less than 1 year were excluded. Outcomes eligible for review included all-cause mortality, cardiac death, sudden death, MI, and all types of stroke. Fatty acids could be given through diet or through supplements. Additionally, references listed in reviews were screened. Two investigators independently extracted data. Another investigator resolved discrepancies. RESULTS: After retrieving 3,625 citations, 20 studies involving 68,680 participants were included. Two trials used dietary counseling to provide omega-3 fatty acids. The rest used supplements. In the 2 trials using dietary fatty acids, all-cause mortality and cardiac death were assessed and showed associations in opposite directions; therefore, with these discrepancies, quantitative synthesis of these trials was not performed.