Analgesia regional, ERAS, cirugía de tórax / Regional analgesia, ERAS protocols, thoracic surgery

Septiembre  10, 2018. No. 3182

Viaje Culinario en Chiapas El papel de las técnicas de anestesia local en los protocolos ERAS para cirugía torácica. The role of local anaesthetic techniques in ERAS protocols for thoracic surgery. Crumley S1, Schraag S1. Author information J Thorac Dis. 2018 Mar;10(3):1998-2004. doi: 10.21037/jtd.2018.02.48. Abstract The use of enhanced recovery after surgery (ERAS), as in other surgical specialties, is an emerging concept in cardio-thoracic surgery but there is still a lack of effective protocols to reduce the burden of surgery on the patient, shorten the period of postoperative recovery, and reduce the likelihood of chronic pain developing. The use of local anaesthetic (LA) techniques, such as thoracic epidural analgesia (TEA) and paravertebral blocks (PVB), as an adjunct to anaesthesia are considered key components, though there is little data for direct comparison of the techniques. This review aims to evaluate the role of LA techniques in a thoracic ERAS program through evidence from literature and considering aspects of clinical practice. We discuss how ERAS is adapting and evolving with the increasing use of video-assisted thoracoscopic surgery (VATS) is thoracic surgery. It also examines the advantages of multimodal, opioid-sparing analgesia in the post-operative period to minimise the inflammatory response and improve functional recovery. LA techniques within ERAS protocols have the potential to hasten recovery when managed appropriately and to their full potential. KEYWORDS: Enhanced recovery; epidural anaesthesia; local anaesthetics (LA); paravertebral block (PVB) PDF Aumento de las vías de recuperación en cirugía torácica del grupo italiano VATS: protocolos de analgesia perioperatoria. Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols. Piccioni F1, Segat M2, Falini S2, Umari M2, Putina O3, Cavaliere L4, Ragazzi R5, Massullo D6, Taurchini M7, Del Naja C7, Droghetti A8. Author information J Thorac Dis. 2018 Mar;10(Suppl 4):S555-S563. doi: 10.21037/jtd.2017.12.86. Abstract Video-assisted thoracoscopic surgery (VATS) is a minimally invasive technique that allows a faster recovery after thoracic surgery. Although enhanced recovery after surgery (ERAS) principles seem reasonably applicable to thoracic surgery, there is little literature on the application of such a strategy in this context. In regard to pain management, ERAS pathways promote the adoption of a multimodal strategy, tailored to the patients. This approach is based on combining systemic and loco-regional analgesia to favour opioid-sparing strategies. Thoracic paravertebral block is considered the first-line loco-regional technique for VATS. Other techniques include intercostal nerve block and serratus anterior plane block. Nonsteroidal anti-inflammatory drugs and paracetamol are essential part of the multimodal treatment of pain. Also, adjuvant drugs can be useful as opioid-sparing agents. Nevertheless, the treatment of postoperative pain must take into account opioid agents too, if necessary. All above is useful for careful planning and execution of a multimodal analgesic treatment to enhance the recovery of patients. This article summarizes the most recent evidences from literature and authors' experiences on perioperative multimodalanalgesia principles for implementing an ERAS program after VATS lobectomy. KEYWORDS: Regional analgesia; pain management; video-assisted thoracoscopic surgery (VATS) PDF Los beneficios de la recuperación mejorada después de los programas de cirugía y su aplicación en la cirugía cardiotorácica. The Benefits of Enhanced Recovery After Surgery Programs and Their Application in Cardiothoracic Surgery. Brown JK1, Singh K1, Dumitru R1, Chan E1, Kim MP1. Author information Methodist Debakey Cardiovasc J. 2018 Apr-Jun;14(2):77-88. doi: 10.14797/mdcj-14-2-77. Abstract The perioperative care of the surgical patient is undergoing a paradigm shift. Enhanced Recovery After Surgery (ERAS) programs are becoming the standard of care and best practice in many surgical specialties throughout the world. ERAS is a multimodal, multidisciplinary, evidence-based approach to care of the surgical patient that aims to optimize perioperative management and outcomes. Implementation, however, has been slow because it challenges traditional surgical doctrine. The key elements of ERAS Pathways strive to reduce the response to surgical stress, decrease insulin resistance, and maintain anabolic homeostasis to help the patient return to baseline function more quickly. Data suggest that these pathways have produced not only improvements in clinical outcome and quality of care but also significant cost savings. Large trials reveal an increase in 5-year survival and a decrease in immediate complication rates when strict compliance is maintained with all pathway components. Years of success using ERAS in colorectal surgery have helped to establish a body of evidence through a number of randomized controlled trials that encourage application of these pathways in other surgical specialties. KEYWORDS: ERAS; cardiothoracic surgery; enhanced recovery after surgery; length of stay; lung resection; multimodal analgesia; transcatheter aortic valve replacement PDF  Inscripciones Abiertas Información / Information Curso de Alta Especialidad en Medicina del Dolor y Paliativa 2019 Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Ciudad de México Convocatoria / Announcement  Congresos Médicos por Especialidades en todo Mundo Medical Congresses by Specialties around the World Información / Information Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information

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