Class of 2017 Abstract / Objectives: To determine if the addition of oral alvimopan, liposomal bupivacaine and intravenous acetaminophen as part of a comprehensive enhanced recovery after surgery (ERAS) program decreases length of stay, recovery time and narcotic/acetaminophen use without affecting colorectal surgery patient outcomes. Methods: Patients were compared before and after the implementation of alvimopan, liposomal bupivacaine and intravenous acetaminophen with an ERAS program. The primary outcome was hospital length of stay (measured in hours). Secondary outcomes included change in time to first meal, bowel sounds, and bowel movement (measured in hours), pain scores (visual analog scale 0-10), opioid use (measured in morphine equivalent milligrams), and acetaminophen use (measured in mg). Results: Thirty-seven individuals were included in the pre implementation population and fifty one patients were included in the post implementation population. The mean length of stay decreased from 124.3 hours to 100.2 hours (P equals 0.13) with the addition of the ERAS program with the three medications. The 24 hour morphine equivalent intervals for seventy-two hours following surgery decreased from 125.8 mg (day 1), 81.9 mg (day 2) and 44.5 mg (day 3) to 44.3 mg (day 1), 22.8 mg (day 2) and 13.2 mg (day 3) (P less than 0.005 for each one). Conclusions: The addition of alvimopan, liposomal bupivacaine and intravenous acetaminophen as part of a comprehensive ERAS program decreased length of stay but not significantly. However, the addition of these three medications with the ERAS program changes was associated with a statistically significant decrease in opioid use.

Class of 2017 Abstract / Objectives: To determine if the addition of oral alvimopan, liposomal bupivacaine and intravenous acetaminophen as part of a comprehensive enhanced recovery after surgery (ERAS) program decreases length of stay, recovery time and narcotic/acetaminophen use without affecting colorectal surgery patient outcomes. Methods: Patients were compared before and after the implementation of alvimopan, liposomal bupivacaine and intravenous acetaminophen with an ERAS program. The primary outcome was hospital length of stay (measured in hours). Secondary outcomes included change in time to first meal, bowel sounds, and bowel movement (measured in hours), pain scores (visual analog scale 0-10), opioid use (measured in morphine equivalent milligrams), and acetaminophen use (measured in mg). Results: Thirty-seven individuals were included in the pre implementation population and fifty one patients were included in the post implementation population. The mean length of stay decreased from 124.3 hours to 100.2 hours (P equals 0.13) with the addition of the ERAS program with the three medications. The 24 hour morphine equivalent intervals for seventy-two hours following surgery decreased from 125.8 mg (day 1), 81.9 mg (day 2) and 44.5 mg (day 3) to 44.3 mg (day 1), 22.8 mg (day 2) and 13.2 mg (day 3) (P less than 0.005 for each one). Conclusions: The addition of alvimopan, liposomal bupivacaine and intravenous acetaminophen as part of a comprehensive ERAS program decreased length of stay but not significantly. However, the addition of these three medications with the ERAS program changes was associated with a statistically significant decrease in opioid use.

Bakgrund: Enhanced Recovery After Surgery (ERAS) är ett vårdprogram skapat för att förbättra återhämtning och minska kroppens stresspåslag efter kirurgi. Det första ERAS- programmet utvecklades år 2012 för kolorektalkirurgi.  Kolorektalcancer drabbar ca 6 400 personer/år i Sverige, och ca 2 600 personer dör årligen. Detta gör det till en av de vanligaste cancerformerna, och den behandlas med kirurgi. Fler och fler sjukhus vårdar patienter, med denna typ av cancer, enligt vårdprogrammet ERAS. Det har visat sig att det har gett patienter en kortare vårdtid, färre komplikationer och i och med detta blir kostnaderna inte lika höga. Syfte: Syftet är att beskriva patienters upplevelse av att vårdas enligt ERAS vid kolorektalkirurgi. Metod: En litteraturöversikt baserat på 10 empiriska studier. Databaserna PubMed och CINAHL användes vid datainsamlingen. Virginia Hendersons omvårdnadsteori utgjorde litteraturöversiktens teoretiska referensram. Resultat: Fem teman identifierades som beskrev patienternas upplevelse av ERAS vid kolorektalkirurgi. Dessa teman var: information, vårdpersonalens bemötande, delaktighet i sin egen vård, nutrition och vårdmiljö. Resultatet visar att mer information behövs och att både informationen och vården måste vara individanpassad. Slutsats: Patienterna upplever inte att ERAS individanpassar informationen vilket gör den svårförstådd och ger en känsla av att inte ha kontroll. Programmet skulle behöva göra individanpassningar för att passa alla typer av patienter och för att kunna ge patienterna möjlighet till att vara delaktiga i sin vård. Genom att vårdpersonal får en ökad förståelse för patienternas upplevelser kan vårdprogrammet förbättras.

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