Intrathecal Analgesia and Restrictive Perioperative Fluid Management within Enhanced Recovery Pathway: Hemodynamic Implications
- 1 June 2013
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of the American College of Surgeons
- Vol. 216 (6), 1124-1134
- https://doi.org/10.1016/j.jamcollsurg.2013.02.011
Abstract
Intrathecal analgesia and avoidance of perioperative fluid overload are key items within enhanced recovery pathways. Potential side effects include hypotension and renal dysfunction. 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. 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 (50%; no patients required dialysis. 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.Keywords
This publication has 42 references indexed in Scilit:
- Randomized clinical trial of goal-directed fluid therapy within an enhanced recovery protocol for elective colectomyBritish Journal of Surgery, 2012
- Impact of Restrictive Intravenous Fluid Replacement and Combined Epidural Analgesia on Perioperative Volume Balance and Renal Function Within a Fast Track ProgramJournal of Surgical Research, 2012
- Laparoscopy in Combination with Fast Track Multimodal Management is the Best Perioperative Strategy in Patients Undergoing Colonic SurgeryAnnals of Surgery, 2011
- A meta-analysis of randomised controlled trials of intravenous fluid therapy in major elective open abdominal surgery: getting the balance rightProceedings of the Nutrition Society, 2010
- A Fast-Track Program Reduces Complications and Length of Hospital Stay After Open Colonic SurgeryGastroenterology, 2009
- Meta-analysis of standard, restrictive and supplemental fluid administration in colorectal surgeryBritish Journal of Surgery, 2009
- Fluid Overload and Surgical OutcomeAnnals of Surgery, 2009
- Impact of Different Crystalloid Volume Regimes on Intestinal Anastomotic StabilityAnnals of Surgery, 2009
- Intraoperative thoracic epidural anaesthesia attenuates stress-induced immunosuppression in patients undergoing major abdominal surgeryBritish Journal of Anaesthesia, 2008
- Meta-analysis of epidural analgesia versus parenteral opioid analgesia after colorectal surgeryBritish Journal of Surgery, 2007