The impact of multimodal therapies on the comfort and safety of patients in the immediate post-anaesthetic period following gynaecological procedures - part II.

OBJECTIVES: The second part of the study was to assess the effects of the types of anaesthesia along with multimodal analgesia on the stability of vital functions at the critical moment of awakening from anaesthesia. MATERIAL AND METHODS: The material comprised the medical records at the Department of Anaesthesiology and Intensive Care in Szczecin. The anaesthesia record forms and recovery room observation charts of 150 patients from the Gynaecology Clinic who had undergone category III and IV surgical procedures between October 2018 and January 2019 were selected for analysis. The patients were divided into three groups: 1. Patients given multimodal analgesia with non-opioid and opioid analgesics. 2. Patients given multimodal analgesia with non-opioid analgesics and adjuvants. 3. Patients given multimodal analgesia with non-opioid and opioid analgesics, as well as neuraxial anaesthesia. RESULTS: The average minimum heart rate in the operating room was 63.92 in group I, 61.48 in group II, and 62.34 in group III. The most common cause of bradycardia during surgery was insufflation. The average SBP prior to surgery was similar in groups I and II - 128.74 and 128.66, respectively. The average maximum values during surgery were 135.24 in group I, 139.34 in group II, and 142.32 in group III. At the time of discharge from the post-anaesthetic care unit, all the patients from the study group had achieved an Aldrete score of 10. Following the anaesthesia, 24% of the patients in group I, 22% in group II, and 28% in group III required oxygen therapy. CONCLUSIONS: When using multimodal analgesia, the time required to fully awaken even after extensive surgical procedures was no longer than two hours.

The impact of multimodal therapies on the comfort and safety of patients in the immediate post-anaesthetic period following gynaecological procedures - part I.

OBJECTIVES: Pain and postoperative nausea and vomiting are among the most unpleasant sensations experienced after surgery. Patients after gynaecological surgery are at higher risk for both complications. Former methods of pain management based mainly on opioid administration were much less safe, especially for elderly patients. In addition, they generated an even greater increase of postoperative nausea and vomiting. Multimodal therapies in anesthesiology are currently being used more and more often. These include both multimodal postoperative pain management and multimodal prophylaxis of postoperative nausea and vomiting. The aim of the study was to assess the benefits of the methods used for gynaecological patients in the immediate postanesthetic period. MATERIAL AND METHODS: The research material is an analysis of medical documentation of 150 patients from the gynaecology clinic who underwent surgical procedures of categories III and IV from October 2018 and until January 2019, carried out in one of the clinical hospitals in Szczecin at the Anesthesiology and Intensive Care Clinic. Patients were divided into 3 groups: 1. Patients who received multimodal analgesia using non-opioid and opioid analgesics. 2. Patients who received multimodal analgesia using non-opioid and opioid analgesics and adjuvants. 3. Patients who received multimodal analgesia using non-opioid and opioid analgesics and central blockade. RESULTS: The highest age was in the third group at 57.48 years of age, 50.86 in the second group, and 47.8 in the first group. Healthy patients classified as ASA 1 accounted for 14% of group I, 18% of group II and 10% of group III. Patients with severe systemic disease (ASA 3) constituted 30% of group III 18%, of group II and 8% of group I. Upon leaving the operating room, as many as 80% of the patients from groups II and III did not feel any pain. In group I was 52%. When entering the recovery room, 26% of the patients in group I, 10% in group III, and 8% in group II rated their pain as higher than 5. The most used antiemetic medication in the studied facility was ondansetron. In group II it was given to 36 (72%) patients, in group III to 23 (46%) patients, and 13 (26%) patients in group I. In the postanaesthetic care unit, 9 (18%) patients in group III, 6 (12%) patients in group I, and 3 (6%) patients in group II received ondansetron. Metoclopramide was given only to patients in group III - one intraoperatively, and the other in the recovery room. CONCLUSIONS: Multimodal analgesia is effective in pain treatment. The use of PONV prevention is used for gynaecological patients. The analysis of the surgical records facilitated the recognition of patient needs.

Implementation of an enhanced recovery after surgery (ERAS) protocol in a gynaecology department - the follow-up at 1 year.

AIM OF THE STUDY: An ERAS protocol provides the latest perioperative care principles, whose primary aim is to reduce complication rates, and therefore mortality. The aim of this study is to establish the progress of the ERAS pathway implementation in our gynaecology department. MATERIAL AND METHODS: This was a retrospective analysis of two sets of 100 consecutive medical records: patients treated before (PRE-ERAS) and after (ERAS) introduction of the ERAS protocol. All patients were comparable and all underwent major gynaecological surgery. Patients as well as medical and nursing staff were informed about the proposed preparation, surgical management and postoperative routine. RESULTS AND CONCLUSIONS: Patients were given supper and drank water during the night. Laparoscopic surgery was used in 44% and spinal anaesthesia was given for open surgery in 43 study patients. Use of drains was reduced only by 23%, bowel preparation by 15%. Intravenous fluid administration was reduced by 22%. Use of postoperative morphine was minimised to 12 patients. Postoperative nausea was managed with the regular use of anti-emetics. Anti-coagulation was given to 80% of the study group. Difficulties in the introduction of the ERAS protocol were due to refusal by some patients to mobilise and eat early postoperatively. Patients in the ERAS programme group were discharged earlier.Further information about the ERAS protocol in the media would facilitate patients' education among conservative society. In order to introduce new and innovative treatment methods, one has to take into account the cultural and ideological factors, especially when patient involvement is essential.