American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) Joint Consensus Statement on Optimal Analgesia within an Enhanced Recovery Pathway for Colorectal Surgery: Part 2-From PACU to the Transition Home.
Abstract
BACKGROUND: Within an enhanced recovery pathway (ERP), the approach to treating pain
should be multifaceted and the goal should be to deliver "optimal analgesia", which
we define in this paper as a technique that optimizes patient comfort and facilitates
functional recovery with the fewest medication side effects. METHODS: With input from
a multidisciplinary, international group of experts and through a structured review
of the literature and use of a modified Delphi method, we achieved consensus surrounding
the topic of optimal analgesia in the perioperative period for colorectal surgery
patients. DISCUSSION: As a part of the first Perioperative Quality Improvement (POQI)
workgroup meeting, we sought to develop a consensus document describing a comprehensive,
yet rational and practical, approach for developing an evidence-based plan for achieving
optimal analgesia, specifically for a colorectal surgery within an ERP. The goal was
twofold: (a) that application of this process would lead to improved patient outcomes
and (b) that investigation of the questions raised would identify knowledge gaps to
aid the direction for research into analgesia within ERPs in the years to come. This
document details the evidence for a wide range of analgesic components, with particular
focus on care in the post-anesthesia care unit, general care ward, and transition
to home after discharge. The preoperative and operative consensus statement for analgesia
was covered in Part 1 of this paper. The overall conclusion is that the combination
of analgesic techniques employed in the perioperative period is not important as long
as it is effective in delivering the goal of "optimal analgesia" as set forth in this
document.
Type
Journal articleSubject
AnalgesiaColorectal surgery
Enhanced recovery pathway
Multimodal
Non-opioid adjuncts
Optimal analgesia
Outcomes
Pain management
Post-discharge
Postoperative
Quality
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https://hdl.handle.net/10161/14226Published Version (Please cite this version)
10.1186/s13741-017-0063-6Publication Info
Gan, Tong Joo; Gordon, DB; Grant, Stuart Alan; McEvoy, MD; Miller, Timothy Ellis;
Mythen, Michael Gerard; ... Wu, CL (2017). American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative
(POQI) Joint Consensus Statement on Optimal Analgesia within an Enhanced Recovery
Pathway for Colorectal Surgery: Part 2-From PACU to the Transition Home. Perioper Med (Lond), 6. pp. 7. 10.1186/s13741-017-0063-6. Retrieved from https://hdl.handle.net/10161/14226.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Tong Joo Gan
Consulting Professor in the Department of Anesthesiology
My current research interests include postoperative nausea and vomiting (PONV), acute
postoperative pain, clinical pharmacology of anesthetic drugs and resuscitation fluids
as well as database research in postoperative outcomes. Improving Outcome in Surgical
Patients: Nausea and vomiting is regarded as one of the most unpleasant experiences
in postoperative recovery. To date, there is no single antiemetic which can satisfactorily
control PONV. My interests concentrate o
This author no longer has a Scholars@Duke profile, so the information shown here reflects
their Duke status at the time this item was deposited.
Stuart Alan Grant
Professor of Anesthesiology
My research interests include regional anesthesia, acute pain management, and ambulatory
anesthesia. Our regional anesthesia group have particular interest in resident education
and ultrasound guided nerve block. We also have an interest in the use of continuous
peripheral catheter systems and liposomal drug delivery systems for prolonged post
operative analgesia. We also investigate the effects of regional anesthesia on patient
outcomes. My ambulatory anesthesia research interes
This author no longer has a Scholars@Duke profile, so the information shown here reflects
their Duke status at the time this item was deposited.
Timothy Ellis Miller
Associate Professor of Anesthesiology
Clinical and research interests are Enhanced Recovery and Perioperative Medicine;
with particular interests in fluid management, and perioperative optimization of the
high-risk non-cardiac surgery patient.
Michael Gerard Mythen
Adjunct Professor in the Department of Anesthesiology
Main area of research interest is the role of gut mucosal hypoperfusion in the pathogenesis
of post-operative organ dysfunction. On-going projects include: i) the effects of
temperature on gut perfusion during cardiopulmonary by-pass, ii) the relationship
between cerebral and splanchnic hypoperfusion during cardiac surgery, iii) the relationship
between gut mucosal hypoperfusion and outcome in patients admitted for surgical intensive
care, iv) the effects of enteral feeding on gut perfusion and
Andrew David Shaw
Adjunct Associate Professor in the Department of Anesthesiology
Dr Shaw is an Associate Professor of Anesthesiology and Critical Care Medicine at
Duke University Medical Center. He is a Fellow of the Royal College of Anaesthetists
(UK) and a Fellow of the American College of Critical Care Medicine. He has practiced
cardiothoracic anesthesiology and critical care medicine for more than 15 years in
the UK and USA, has authored 3 textbooks and more than 100 original papers. He currently
runs the iPEGASUS initiative, an international surgical outcomes conso
Julie K. Marosky Thacker
Associate Professor of Surgery
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