This study compares 2 different ways of perioperative management in patients of peptic perforation. Experimental arm is the ERAS arm( Enhanced recovery after surgery) and the comparative arm is Conventional arm.
While the conventional approach to perioperative management can potentially prolong the post operative hospital stay, ERAS(Enhanced recovery after surgery), a multi-modal and multispeciality approach to perioperative management may reduce the length of hospital stay. In the preoperative period, patients will be counselled regarding the operative procedure and particulars of the perioperative management.In the intra-operative period short acting general anesthetic agents and short acting muscle relaxants will be used.Intravenous fluid administration will be goal directed. After the operative procedure, bilateral rectus sheath block will be administered. Patient will also receive post-operative nausea and vomiting prophylaxis. Nasogastric tube will be removed immediately after the operative procedure. In the post operative period, patients will be encouraged to ambulate early. Enteral nutrition will be initiated as early as possible. Indwelling catheters will be removed in the early post-operative procedure.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
60
* Tracheal intubation and with General anesthesia * Short acting anesthetic agents,avoid opioid agents * Omental patch repair with placement of sub hepatic drain * Bilateral Transverse abdominis plane block/ Rectus sheath block immediately after surgery. * Post operative nausea and vomiting prophylaxis. * Encourage to mobilize out of bed after effect of general anesthesia has weaned off. * Initiation of feeding-Oral sips on day 1, step up day 2 onward * Removal of nasogastric tube-immediately after surgery after aspirating the gastric content through nasogastric tube. * Removal of urinary catheter-after weaning from the effect of general anesthesia. * Sub hepatic drain removal -anytime within 24 hours;drain will not be removed if fluid is bilious or pus. * Avoid opiod analgesics.
Tracheal intubation * Short acting anesthetic agents, avoid opiod anesthesia agents. * Omental patch repair along with sub hepatic drain placement. * Post operative nausea and vomiting prophylaxis. * Ambulation-as per patients' own request. * Initiation of oral feed- after passage of 1st flatus. * Nasogastric tube removal-output \<300ml/day with resolution of ileus. * Removal of urinary catheter- when patient sits on bed side/ambulate. * Removal of sub hepatic drain-when patient tolerates unrestricted amount of liquid diet and drain output is less than 200 ml /day. * Patient will receive opiod analgesics.
Tushar S Mishra
Bhubaneswar, Odisha, India
Length of hospital stay
Duration from the time of operation to time of discharge
Time frame: Post operative period up-to one month.
Recovery of functional parameters
* Time of withdrawal of nasogastric tube (hours) * Time to first bowel sound (hours) * Time to first flatus (hours) * Time to first stool (hours) * Time to removal of drain(hours) * Time to first fluid diet (hours) * Time to first solid diet (hours) * Time to stoppage of IV fluids(hours) * Time of removal of urinary catheter (hours) * Time to ambulation(hours)
Time frame: Post operative period up-to one month.
Post operative complications
* Anastomotic leakage * Pneumonia * Ileus * Obstruction * Wound infection * Abdominal sepsis * Burst Abdomen * Need for reinsertion of nasogastric tube * Need for reinsertion of urinary catheter * Need for drainage of abdominal collection * Readmission * Re operation * Mortality
Time frame: Post operative period up-to three months.
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