The pharmacist's role in optimizing medication management before, during, and after minimally invasive and bariatric surgery.

DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: Minimally invasive surgery (MIS) with integrated enhanced recovery pathways (ERPs) helps reduce length of stay and improve surgical outcomes. As these procedures have become more prevalent over time, pharmacists are in key positions to manage medications in the perioperative space to help optimize transitions of care and reduce safety events. Here we identify several clinical areas across phases of care for these procedures in which the knowledge and guidance of pharmacists, as members of the interprofessional team, are paramount. SUMMARY: Perioperative pharmacy expertise is often required for MIS procedures in the areas of acid suppression, antithrombotic management, blood glucose control, drug formulation, immunosuppressant optimization, pain mitigation, and postoperative nausea and vomiting prevention and treatment. For each MIS procedure, pharmacists should identify and consider diet and anatomical changes as well as patient- and surgery-specific risk factors. Pharmacists can then utilize their knowledge of the pharmacokinetics and pharmacodynamics of individual medications along with evidence-based medicine to recommend selection of appropriate agents. CONCLUSION: Pharmacist contributions to perioperative medication management for MIS procedures can improve care as surgical patients navigate transitions through the perioperative setting. Pharmacists can further incorporate medication expertise through development and implementation of institutional MIS protocols within the context of ERPs. As such, any pharmacist should feel empowered to aid in the care of surgical patients.

A retrospective analysis of intravenous acetaminophen use in spinal surgery patients / Análisis retrospectivo del uso de paracetamol intravenoso en pacientes con cirugía medular

Objective: This study aimed to determine if intravenous acetaminophen [paracetamol] (IV APAP) could decrease visual analog pain scores (VAS), opioid exposure and subsequent opioid related adverse effects (nausea, vomiting, constipation) in spinal surgery patients. Methods: Thirty four spinal surgery patients to date have received IV APAP since its addition to the formulary at our institution. The electronic medical record was accessed on all patients who received at least one dose pre or post operatively to collect postoperative opioid consumption (in morphine equivalents), number of antiemetic and laxative doses, use of naloxone, and VAS pain scores from arrival to surgical unit through postop day two. An equivalent number of patients who did not receive any IV APAP were selected and matched on the basis of opioid use prior to admission, surgery type, surgeon, age, and sex to constitute the control group. Results: The IV APAP group used significantly less opioids than the control group (p=0.015). Frequency of antiemetic and laxative use and VAS pain scores did not differ significantly between the two groups. Conclusions: It appears IV APAP can be used effectively as an adjuvant pain management therapy in spinal surgery patients to decrease opioid exposure, but does not necessarily reduce the incidence of opioid related adverse effects or VAS pain scores (AU)

Objetivo: Este estudio trato de determinar si el paracetamol [acetaminofén] intravenoso (IV APAP) podría disminuir la puntuación de la escala visual analógica del dolor (VAS), el uso de opioides y los subsiguientes efectos adversos de los opioides (nausea, vómitos, estreñimiento) en pacientes con cirugía medular. Métodos: En nuestra institución, hasta la fecha, 34 pacientes con cirugía medular han recibido IV APAP desde su incorporación al formulario. Para recoger el consumo post-operatorio de opioides (en equivalentes de morfina), el número de antieméticos y las dosis de laxantes, uso de naloxona, así como las puntuaciones de la VAS de dolor, se accedió a las historias clínicas electrónicas de todos los pacientes que recibieron al menos una dosis pre o post-operatoria desde su ingreso en la unidad quirúrgica hasta el día 2 post-operatorio. Para constituir el grupo control, se seleccionó un número equivalente de pacientes que no recibió IV APAP y se emparejó en base a uso de opioides previo al ingreso, tipo de cirugía, cirujano, edad y sexo. Resultados: El grupo IV APAP utilizó significativamente menos opioides que el grupo control (p=0,015). La frecuencia de uso de antieméticos y laxantes y las puntuaciones de la VAS de dolor no fueron significativamente diferentes en los dos grupos. Conclusiones: Parece que el IV APAP puede usarse efectivamente como adyuvante del tratamiento del dolor en pacientes con cirugía medular para disminuir la exposición a opioides, aunque no necesariamente se reduce la incidencia de efectos adversos de los opioides o las puntuaciones de la VAS de dolor (AU)