Postoperative

 

  • Optimal analgesia w/ minimal side effects (opioid-sparing strategies)

    • Regional anesthesia

      • Thoracic epidural (T6-T11): gold standard in open abdominal surgery

      • TAP blocks, continuous wound infusion 

    • Multimodal regimens

      • NSAIDs, acetaminophen

      • IV lidocaine infusion

      • Consider gabapentinoids, IV ketamine, high-dose steroids

  • Postop delirium

    • Prevention: avoid prolonged fasting, deep anesthesia, delirogenic rx; maintain sleep-wake cycle 

    • Systematic delirium screening

    • Symptom-oriented treatment

    • Rule out potential underlying medical causes

  • Postop ileus: Multimodal prevention strategies

    • Laparoscopic if possible

    • TEA, opioid-sparing strategies

    • Avoid excess fluid, mobilization, early feeding/gum chewing, no prophylactic NGT

  • Early mobilization

    • Multidisciplinary approach

    • Daily targets & recording of physical activity

 

 

Adapted from Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice. Acta Anaesthesiologica Scandinavica 60 (2016) 289–334

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