036 Major lower gastro‐intestinal surgery peri‐operative service evaluation project (RESECT)
Published Date: 01st May 2020
Publication Authors: Herold J, Dixit T
St Helens and Knowsley Teaching Hospitals NHS Trust is the centre for the largest number of bowel resections within the region, with the aim of becoming a tertiary unit for major lower gastro‐intestinal (GI) surgery. Due to the nature of the operations performed, peri‐operative management and analgesic control is difficult and complex to achieve. The project's aims were to help standardise care by evaluation of the service currently provided, highlighting good practice measures into a unified enhanced recovery pathway.
Methods
Prospective data collection was undertaken from February to April 2019. The goal was to collect 20–25 data sets. Forms were filled in by the anaesthetic team; the second was filled in by the patients in the form of a pain diary. Data were collected on weekdays by the anaesthetic team, only for cases of planned bowel resection. Missing data from the anaesthetic data worksheet were gathered from the hospital electronic record system. Patients were then asked to fill out a pain dairy/survey covering the immediate postoperative period, and the subsequent 2 days after surgery. These patient surveys were also reviewed by the acute pain team to improve patient comfort.
Results
From February to April of 2019, we were able to collect 21 sets of data. Patients’ average age was 58 years with 10 male and 11 female patients. Of the 21 patients, 15 had surgeries due to cancer. ASA grade ranged from I–IV with 11 patients ASA II. Seven patients received spinal and general anaesthesia, five patients received bilateral tap blocks and rectus sheath blocks and general anaesthesia, and nine patients received general anaesthesia as primary mode of anaesthetic. Pain scores were variable: out of the 21 patients, four reported pain scores > 5 in recovery. On day 1 post‐surgery, five patients reported scores > 5. Two patients reported pain scores of 10 on day 2 post‐surgery.
Discussion
In the immediate postoperative period, patients that received regional anaesthetic reported lower pain scores, allowing early mobilisation, which reduces non‐surgical complication rates [1]. Ward staff were quick to respond to patients need for further analgesia. Acute pain services allowed for better management of pain, deceasing length of stay. Following this project, a draft enhanced recovery programme for colorectal resections will be trialled.
Herold, J; Dixit, T; Awolumate, B. (2020). 036 Major lower gastro‐intestinal surgery peri‐operative service evaluation project (RESECT). Anaesthesia. 75 (S2), 26.