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Intrathecal analgesia and restrictive perioperative fluid management within enhanced recovery pathway: hemodynamic implications.
- Source :
-
Journal of the American College of Surgeons [J Am Coll Surg] 2013 Jun; Vol. 216 (6), pp. 1124-34. Date of Electronic Publication: 2013 Apr 23. - Publication Year :
- 2013
-
Abstract
- Background: Intrathecal analgesia and avoidance of perioperative fluid overload are key items within enhanced recovery pathways. Potential side effects include hypotension and renal dysfunction.<br />Study Design: From January 2010 until May 2010, all patients undergoing colorectal surgery within enhanced recovery pathways were included in this retrospective cohort study and were analyzed by intrathecal analgesia (IT) vs none (noIT). Primary outcomes measures were systolic and diastolic blood pressure, mean arterial pressure, and heart rate for 48 hours after surgery. Renal function was assessed by urine output and creatinine values.<br />Results: One hundred and sixty-three consecutive colorectal patients (127 IT and 36 noIT) were included in the analysis. Both patient groups showed low blood pressure values within the first 4 to 12 hours and a steady increase thereafter before return to baseline values after about 24 hours. Systolic and diastolic blood pressure and mean arterial pressure were significantly lower until 16 hours after surgery in patients having IT compared with the noIT group. Low urine output (<0.5 mL/kg/h) was reported in 11% vs 29% (IT vs noIT; p = 0.010) intraoperatively, 20% vs 11% (p = 0.387), 33% vs 22% (p = 0.304), and 31% vs 21% (p = 0.478) for postanesthesia care unit and postoperative days 1 and 2, respectively. Only 3 of 127 (2.4%) IT and 1 of 36 (2.8%) noIT patients had a transitory creatinine increase >50%; no patients required dialysis.<br />Conclusions: Postoperative hypotension affects approximately 10% of patients within an enhanced recovery pathway and is slightly more pronounced in patients with IT. Hemodynamic depression persists for <20 hours after surgery; it has no measurable negative impact and therefore cannot justify detrimental postoperative fluid overload.<br /> (Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Colorectal Neoplasms surgery
Female
Follow-Up Studies
Humans
Hypotension physiopathology
Male
Middle Aged
Retrospective Studies
Treatment Outcome
Analgesia, Epidural methods
Colorectal Surgery
Fluid Therapy methods
Hemodynamics physiology
Hypotension therapy
Perioperative Care methods
Recovery of Function physiology
Subjects
Details
- Language :
- English
- ISSN :
- 1879-1190
- Volume :
- 216
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Journal of the American College of Surgeons
- Publication Type :
- Academic Journal
- Accession number :
- 23623218
- Full Text :
- https://doi.org/10.1016/j.jamcollsurg.2013.02.011