ESRA19-0149 Breast surgery

Le résumé fourni par la source

Fast-tract rehabilitation is an interdisciplinary, multimodality concept to accelerate postoperative convalescence, improved post-operative analgesia and reduced post-operative nausea and vomiting and reduce general morbidity. The ERAS pathway was developed by a multidisciplinary team, addressing the needs of the patient in the preoperative, intraoperative and postoperative periods. It is difficult to ascertain which components of our ERAS-based care pathway are most responsible for improvement in patient outcomes. the goals of the perioperative anesthesiology pathway were achieving superior analgesia, minimising postoperative nausea and vomiting, facilitating patient recovery, and preserving perioperative immune function. In the preoperative period, patients receive educational materials about what to expect with their care, as well as detailed information about their multimodal pain regimen, including Pecs blocks. It is administered paracetamol, gabapentin, plus minor celecoxib, and avoidance of prolonged fasting. Intraoperatively patient receives regional techniques, including pecs, serratus plane block, paravertebral or rectus sheath block (microvascular abdominal based breast reconstruction). Preferably total intravenous analgesia (propofol and fentanyl if needed), dexamethasone, ondansetron and trying to avoid opioids amount. Postoperatively paracetamol, diclofenac or celecoxib, gabapentin and oxycodone is provided, depending on different protocols. Early mobilization and early oral intake are always emphasized after surgery. ERAS patients has shown lower pain scores over the course of their hospital stay despite reduction in the use of opioid analgesics.

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