Enhanced Recovery Protocols (ERPs or bundles) have been established in many surgical specialties (such as colon cancer and orthopaedic joint surgeries) for several years in hospitals worldwide. The principles of Enhanced Recovery Protocols are those of early mobilization and restoration of normal function as soon as possible after surgery. These principles are achieved by use of alternate pain control regimens and removing invasive lines and drains as soon as possible. The benefits of ERPs are improved patient experience, earlier return to normal function and reduced length of stay. Enhanced recovery protocols for cardiac surgery have been published by the Enhanced Recovery After Cardiac Surgery Society. The current study will investigate whether it is possible to utilise ERP bundles in the population of cardiac surgery patients at James Cook Hospital, with a view to rolling out a full ERP service. Secondary study outcomes will be patient-centred, including; pain scores, nausea and vomiting rates and time taken to return to normal function.
Why? Enhanced Recovery Protocols (ERPs or bundles) have been established in many surgical specialties (such as colon cancer and orthopaedic joint surgeries) for several years in hospitals worldwide. The principles of Enhanced Recovery Protocols are those of early mobilization and restoration of normal function as soon as possible after surgery. These principles are achieved by use of alternate pain control regimens and removing invasive lines and drains as soon as possible. The benefits of ERPs are improved patient experience, earlier return to normal function and reduced length of stay. Enhanced recovery protocols for cardiac surgery have been published by the Enhanced Recovery After Cardiac Surgery Society. These protocols have been demonstrated as safe, though have yet to make it into mainstream practice in the UK. The use of ERPs in Cardiac Surgery has the potential to greatly improve the patient journey and hospital efficiency. What? The current study will investigate whether it is possible to utilise ERP bundles in the population of cardiac surgery patients at James Cook Hospital, with a view to rolling out a full ERP service. Secondary study outcomes will be patient-centred, including; pain scores, nausea and vomiting rates and time taken to return to normal function. Who? All adult patients over the age of 18 years and listed for cardiac surgery will be considered for inclusion in this study. Where? The study population will be comprised of patients undergoing cardiac surgery at the James Cook University Hospital in Middlesbrough. How? Study duration will be 6 months, with 80 patients (comprising a control and intervention group)
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
80
Pre-operative Carbohydrate PreLoad drink, 1 sachet given the night before surgery. One sachet given 2-4hours before surgery.
One dose of Gabapentin pre-operatively, 300mg orally.
One dose of Lansoprazole pre-operatively, 30mg orally.
One dose of Paracetamol intra-operatively, 1gram intravenous infusion.
One dose of Dexamethasone intra-operatively as an anti-emetic, 8mg intravenous.
One dose of Ondansetron intra-operatively as an anti-emetic, 4mg intravenous
Infiltration of surgical wounds with local anaesthetic at the end of surgery, Bupivacaine 1-2mg/kg.
One infusion of intravenous Magnesium Sulphate intra-operatively as an analgesic, 50mg/kg given over 30minutes.
Post-operative oral Gabapentin 300mg, three times daily as an analgesic.
Post-operative Paracetamol as an analgesic. Initially intravenously, then orally. One gram four times daily.
Intravenous Ondansetron administered post-operatively as prophylactic anti-emesis. 4mg three times daily, for 24 hours. Then as required.
Removal of the endotracheal tube in the Intensive Care Unit as soon as is safe.
Mobilisation (active and passive limb movements, deep breathing) with the assistance of nurse/physiotherapist to occur as soon as possible post-operatively.
Patients will be encouraged to start eating as soon as possible post-operatively
James Cook University Hospital
Middlesbrough, Teeside, United Kingdom
RECRUITINGERAS bundle compliance in the first 48hours post-op
Number of interventions for the ERAS protocol that are delivered to patient (numeric data e.g. 6 out of 10)
Time frame: 48hours post op
Time to extubation
Time taken until patient extubated (ETT) post op (in minutes)
Time frame: 0-24hours
Time to mobilisation
First mobilisation with nurse/physiotherapist post-op (in minutes)
Time frame: 0-48hours
Time to oral diet
Time until patient first eats post-op (in minutes)
Time frame: 0-48hours
Post-op pain
Pain scores at 6hours, Numeric scale 0 (no pain) - 10 (severe pain)
Time frame: 6hours
Post-op pain
Pain scores at 12hours, Numeric scale 0 (no pain) - 10 (severe pain)
Time frame: 12hours
Post-op pain
Pain scores at 24hours, Numeric scale 0 (no pain) - 10 (severe pain)
Time frame: 24hours
Quality of Recovery
Quantification of patient quality of recovery. Using Q-o-R 15 Scale internationally validated scale. This allows the patient to report on a numerical scale from 0 (not at all) to 10 (all of the time); the patients scores on aspects of recovery such as pain at rest, pain on movement, quality of sleep, presence of nausea and vomiting, feeling supported by medical staff.
Time frame: 6 weeks post surgery
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