The concept of early rehabilitation (fast track) in operative gynecology

Abstract

Introduction. Application of laparoscopic techniques corresponds to the principles of the FTS maximally. Aim – to assess the impact of the early multimodal rehabilitation concept use on the postoperative period. Material and Methods. The study involved 39 patients who were randomized by method of envelopes into two groups. In the basic group (20 patients) a multimodal protocol of early rehabilitation was used. In the control group (19 patients) a traditional perioperative regimen was performed. In both groups, vaginal hysterectomy with laparoscopic support under general anesthesia combined with mechanical ventilation was carried out. Fentanyl analgesia (5 - 3 mcg / kg / hr) and 0.5% bupivacaine solution into epidural space (6.8 mL) were given. The volume of the infusion in the main group was 5 - 6 ml / kg / h, in the control group - 10 ml / kg / hr. The perioperative analgesia included NSAIDs (deksetoprofen, ketorolac, paracetamol). Noninvasive monitoring was carried out by monitor "Leon" (blood pressure, heart rate, capnogram), the hourly diuresis was taken into account, and thermometry was done. Postoperatively in both groups 24 hours prolonged epidural analgesia with small boluses of 0.25% bupivacaine solution (4 ml / hour) in combination with systemic injection of dexketoprofen (100-150 mg / day) + ketorolac (60 mg / day) + paracetamol (2000 mg / day) was used. Results. The groups were homogeneous by anamnestic (the onset of menstruation, number of pregnancies, childbirths, induced abortions, spontaneous abortions), anthropometric and demographic characteristics, by the duration of operations and the reference levels of systolic, diastolic, mean arterial pressure and heart rate. The volume of blood loss (ml) in patients with FTS was (282 ± 22), in patients of the control group - (347±21), p˂0.05. Intraoperative hemohydrobalance (ml) in patients with FTS was (547 ± 57), in the control group - (942 ± 62), p˂0.05. The postoperative bed-day index in patients of the main group (FTS) was significantly lower (5.00 ± 0.26) than in the control group of patients without FTS (7.16 ± 0.40), p˂0.05. Conclusions. Optimal anesthetic tactic allows patients to be extubated quickly and to eliminate postoperative pain in the first 24 hours effectively. Using the early multimodal rehabilitation protocol reduces the time of patients’ recovery after vaginal hysterectomy with laparoscopic assistance.

Keywords

• rehabilitation
• vaginal hysterectomy
• postoperative