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ANALGESIA FOR MAJOR COLORECTAL SURGERY AS PART OF ENHANCED RECOVERY PROGRAMME AT SANDWELL GENERAL HOSPITAL
ESRA Academy. Willetts E. Sep 8, 2016; 138226
Topic: Acute Postoperative Pain - Postoperative & Perioperative Analgesia
Elizabeth Willetts
Elizabeth Willetts

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Abstract
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Background and Aims:

Enhanced Recovery After Surgery (ERAS) programmes are a group of evidence-based strategies aiming to optimize perioperative patient care. Good analgesia is one such strategy. This audit was carried out to assess current analgesia practice in major colorectal surgery as part of the ERAS programme at Sandwell General Hospital. 

Methods:

A retrospective audit of analgesia for major colorectal surgery from November 2014 to January 2015 was performed. Data collected included patient characteristics, surgical approach, analgesia, pain scores and patient satisfaction. It was approved by the local audit department.

Results:

Data was collected from 36 patients (23 open, 13 laparoscopic). Of the open cases, 73.9% had an epidural; the remaining had patient controlled analgesia (PCA). The majority of laparoscopic cases had a PCA (76.9%); the remaining had an epidural (15.4%) or a spinal with diamorphine (7.7%). The epidural failure rate within 24 hours was 36.8%. Paracetamol was used in 77.8% intraoperatively and 97.2% postoperatively. Non-steroidal anti-inflammatory drugs were used in 13.9% intraoperatively and 19.4% postoperatively. PCA morphine use was poorly documented. Overall 86.1% patients were either satisfied or very satisfied with their analgesia, only 2.7% were very unsatisfied. Lack of good documentation, staff engagement and dedicated colorectal anaesthetists was observed.

Conclusions:

PCA or epidural analgesia was used with minimal use of multimodal analgesia or other regional techniques. Following these results, a protocol for standardized analgesia was produced. This will be implemented as part of the revised ERAS protocol and will be monitored for compliance and efficacy.

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