Application of the accelerated rehabilitationprotocol (ERAS) in the perioperative period from the position of an anesthesiologist

Abstract

Introduction. Application of laparoscopic techniques corresponds to the principles of the ERAS maximally. Aim – assess the impact of the early multimodal rehabilitation concept use on the postoperative period. Material and methods. The study involved 49 patientswhowererandomizedbymethodofenvelopes into two groups. In the basic group (30 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 (3–5 mcg/kg/hr), and 0,5% bupivacaine solution into epidural space (6,8 mL). The volume of the infusion in the main group was 6 ml/kg/h, in the control group – 10 ml/kg/hr. Noninvasive monitoring carried by monitor "Leon" (blood pressure, heart rate, capnogram), the hourly diuresis. Postoperatively the two groups used 24 hours prolonged epidural small boluses of 0,25% bupivacaine solution (4 ml/hour) in combination with systemic administration of dexketoprofen (100–150 mg/day) + ketorolac (60 mg/day) + paracetamol (2000 mg/day). Result. The groups were homogeneous in anamnestic (onset of menstruation, number of pregnancies, childbirth, abortion, miscarriage), anthropometric and demographic characteristics, duration of operations and the beginning levels of systolic, diastolic, mean arterial pressure and heart rate. The volume of blood loss (ml) in patients with ERAS was (282 ± 22), in patients of the control group – (347 ± 21), p˂0,05. Intraoperative gemohydrobalance (ml) in patients with ERAS was (547 ± 57), in the control group – (942 ± 62), p ˂ 0,05. The postoperative hospital stay in patients of the main group (ERAS) was significantly shorter (5,00 ± 0,26) than in the control group of patients without ERAS (7,16 ± 0,40), p ˂ 0,05. Conclusion. Optimal anesthetic tactic allows patients to be fast extubated and to eliminate postoperative pain in the first 24 hours effectively. Using the early multimodal rehabilitation protocol reduces the time of patient recovery after vaginal hysterectomy with laparoscopic assistance.

Keywords

• multimodal strategy
• laparoscopy
• vaginal hysterectomy