TAP Blocks and Same Day Lap Choli Surgery

Jeff Halonen, DO

The Beneficial Effects of Transverse Abdominid Plane Block After Laparoscopic Cholecystectomy in Day-Case Durgery: A Randomized Clinical Trial. Premillennialism Lykke Petersen, MD et al. Anesthesiology. September 2012- Vol 115- Number 3, p 527-533.

Summary

Patients generally have moderate pain in the early postoperative period following. There have been RCT's that suggest the use of transversal abdominis block following abdominal surgeries for analgesia. The purpose of this trial was to see of this TAP block could decrease the pain with rest and coughing, decrease opioid use and side effects after laparoscopic cholecystectomies in day-case surgery.

This trial put patients into one of two categories. One received bilateral TAP block with Ropivicaine while the other received a placebo block. Their goal was then to see if there was a difference in the above measures.

What was found was that there was a difference in the pain scores when coughing and total opioid consumption. These differences were thought to only be a small difference however.

Bis monitoring and recovery in Ambulatory Anesthesia

Dr. Cartier

Anesthesiology:

October 1997 - Volume 87 - Issue 4 - p 842–848

Song, Dajun MD, et al

“Titration of Volatile Anesthetics Using Bispectral Index Facilitates Recovery after Ambulatory Anesthesia”

This prospective, randomized study was designed to evaluate the usefulness of bispectral index (BIS) in the wake-up period of anesthesia.  Several groups were assigned to receive various forms of maintenance anesthesia, including Desflurane, Sevoflurane, nitrous oxide, and fentanyl, and some combinations thereof.  The control groups were blinded to the BIS number, while others attempted to titrate their anesthetics to approximately 60.  In the end, those anesthesia providers who used the BIS to titrate their anesthetics had higher BIS numbers, used less volatile anesthetics, and had quicker verbal responsiveness times.

Fast-Tracking and Modified Aldrete Score

Vimmi Kang, DO

New Criteria for Fast-Tracking After Outpatient Anesthesia: A Comparison with the Modified Aldrete’s Scoring System

Paul F. White, PhD, MD, FANZCA and Dajun Song, MD, PhD

A & A May 1999 vol. 88 no. 51069-1072

The modified Aldrete’s scoring system is commonly used for determining when patients can be safely discharged from the PACU to either the postsurgical ward or to the second stage (Phase II) recovery area. Recently, these discharge criteria have also been used in the OR to determine the fast-track eligibility of outpatients undergoing ambulatory surgery. The modified Aldrete’s scoring system is a highly acceptable criteria for discharging patients from the PACU. However, this scoring system was not designed to assess the patient’s ability to bypass the PACU after major ambulatory procedures under general anesthesia. So a new criteria was compared to the modified Aldrete scoring system to see which one was more structured to fit fast tracking after outpatient anesthesia.

Recovery data from 216 consenting female outpatients undergoing either laparoscopic tubal ligation or cholecystectomy procedures at the University of Texas Southwestern Medical Center at Dallas from January 1997 through July 1998 were analyzed. General anesthetics were either maintained by inhaled anesthetics (desflurane, sevoflurane) or Propofol. Early recovery status was evaluated at 1-min intervals after termination of the anesthetics using both the modified Aldrete scoring system  and the new fast-track scoring system. Patients were considered fast-track–eligible if they achieved a score of 10 using the modified Aldrete scoring system or a score of ≥12 (with no score <1 in any individual category) using the new scoring system.

In conclusion, The results from this data evaluation demonstrated that 22%–29% of outpatients judged fast-track–eligible using the modified Aldrete scoring system subsequently required IV analgesics and antiemetics. Although these patients were fully oriented and had stable vital signs, they would have added to the workload of the Phase II nursing staff and may have necessitated the use of more extensive monitoring in the step-down unit. So, the new fast-track scoring system seems to offer advantages over the modified Aldrete’s scoring system in evaluating the suitability of outpatients for bypassing the PACU after undergoing ambulatory surgery with general anesthesia.

Can you bypass PACU for Outpatient Knee Surgery?

Cameron Cartier, DO

Article Review

PACU Bypass after Outpatient Knee Surgery Is Associated with Fewer Unplanned Hospital Admissions but More Phase II Nursing Interventions

Anesthesiology:

October 2002 - Volume 97 - Issue 4 - pp 981-988

This prospective study was designed to compare post-operative complications of patients who bypassed PACU with those who went to PACU following outpatient knee surgery.  The patients receiving the outpatient knee surgery were evaluated based upon a new criteria to separate whether or not the patients would bypass the PACU.   Eighty-seven percent of the patients bypassed the PACU.  These patients required more nursing interventions in the step-down unit, but required less hospitalizations secondary to anesthetic complications.  This article shows that hospital based criteria may be considered in specific patient populations in order to help decrease the amount of recovery time needed for patients to help save the hospital time, money, and staff.