Authors (including presenting author) :
Chan NC(1), Chu HM(1)
Affiliation :
(1) Department of Anaesthesia, Pamela Youde Nethersole Eastern Hospital
Introduction :
Patients undergoing major gynae-oncological surgeries are at risk of significant pain and prolonged hospital stay, potentially delaying their subsequent adjuvant therapy. ERAS was introduced in PYNEH to expedite their recovery.
An evidence-based protocol with multidisciplinary collaboration was introduced in the perioperative management. Our department focused on preoperative optimization and effective pain control. Besides the standard patient-controlled analgesia (PCA), pain management was enhanced by preoperative education, preventive multimodal analgesics and regional anaesthesia. The programme started in July 2020. Initially only one patient per week could be included into the programme (Phase 1). It was fully launched in April 2021 to all patients fulfilling the inclusion criteria (Phase 2).
Objectives :
The primary outcome was duration of PCA use. Secondary outcomes were pain scores, total morphine consumption, incidence of postoperative nausea and vomiting (PONV), blood loss, transfusion rate and length of stay (LOS).
Methodology :
It was a retrospective audit to all patients under ERAS from July 2020 to October 2021. Comparable cases from 2019 were used as control. ERAS patients were subdivided into phase 1 and phase 2 according to the operative date. Kruskal Wallis test and Chi-square tests were used for analyses.
Result & Outcome :
39 ERAS patients (20 in phase 1; 19 in phase 2) were compared with 23 control patients. No significant differences were found in their basic demographics.
The duration of PCA use was significantly shorter in ERAS (1.65 days in phase 1; 1.28 days in phase 2; 2 days in control, p-value <0.05). Their pain score was lower on postoperative day (POD) 2 (4.84 in phase 1; 3.27 in phase 2; 5.5 in control, p-value <0.05).
The mean LOS was 8.05 days in phase 1, 6.42 days in phase 2 and 11 days in control (p = 0.284). Though significant difference was not found, greater variance in the LOS was observed in control group. The small sample size could contribute to the lack of statistical significance. Further audit would be warranted to explore the potential benefit to LOS.
There were no significant differences in blood loss, transfusion, total morphine consumption, POD 1 pain score and PONV. Pain control was convincingly improved with ERAS. Other patient outcomes will be investigated in the coming audits.
