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    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.

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    Date
    2017
    Authors
    Gan, Tong Joo
    Gordon, DB
    Grant, Stuart Alan
    McEvoy, MD
    Miller, Timothy Ellis
    Mythen, Michael Gerard
    Perioperative Quality Initiative (POQI) I Workgroup
    Scott, MJ
    Shaw, Andrew David
    Thacker, Julie K Marosky
    Wu, CL
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    (11 total)
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    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 article
    Subject
    Analgesia
    Colorectal surgery
    Enhanced recovery pathway
    Multimodal
    Non-opioid adjuncts
    Optimal analgesia
    Outcomes
    Pain management
    Post-discharge
    Postoperative
    Quality
    Permalink
    https://hdl.handle.net/10161/14226
    Published Version (Please cite this version)
    10.1186/s13741-017-0063-6
    Publication 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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    Scholars@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.
    Grant

    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.
    Miller

    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
    Shaw

    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
    Thacker

    Julie K. Marosky Thacker

    Associate Professor of Surgery
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