Enhanced Recovery After Laparoscopic Colorectal Surgery Study

Impact of Enhanced Recovery (ERAS) Protocol After Laparoscopic Colorectal Surgery Implementation on Clinical Outcomes

The study will assess the impact on quality of care after implementation of the ERAS (Enhanced Recovery After Surgery) protocol for laparoscopic colorectal surgery in Vilnius University Hospital Santaros klinikos. The primary goal of this study is to compare efficacy of two different types of anaesthesia - general and combined (spinal and general), efficacy of multimodal analgesia in both groups, need for rescue analgetics, time to bowel movement, time to ambulation. We also aim to study overall patient satisfaction and measure health-related quality of life, from date of randomisation until the date of hospital discharge, 30 days, 3 months and 6 months post-discharge.

Recovery After Surgery (ERAS) protocol is a multimodal perioperative care pathway designed to achieve early recovery after surgical procedures by maintaining preoperative organ function and reducing the profound stress response following surgery, now widely accepted in laparoscopic colorectal surgery.

In laparoscopic colorectal surgery, the ERAS protocol involves an accurate interview with the patient in the preoperative phase aimed at smoking and alcohol cessation, the reduction of preoperative fasting with administration of oral carbohydrates before surgery, use of intestinal preparation for selected cases only, the prophylaxis of thromboembolism, a correct antibiotic prophylaxis, the prevention of intraoperative hypothermia and hypotension, prevention of volume overload, preference for minimally invasive surgery, multimodal analgesia with reduced opioid requirements, local anaesthetics for wound infiltration, prevention of postoperative nausea and vomiting, very limited use of the nasogastric tube, early removal of the urinary catheter, multimodal analgesia to minimize opiate consumption, early postoperative mobilization and early postoperative feeding, to promote rapid recovery of gastrointestinal functions.

Inclusion Criteria:

• 18 years of age and older.
• scheduled for laparoscopic colorectal surgery.
• patient informed and having accepted the principle of enhanced recovery after surgery.
• patient written consent will be obtained preoperatively for eligible study participants.

Exclusion Criteria:

Preoperative:

• patients who can not comply with the ERAS protocol because they do not understand the language or has a cognitive disorder.
• patients with a documented allergy to nonsteroidal anti-inflammatory drugs and acetaminophen.
• preoperative renal insufficiency (creatinine clearance less than or equal to 30ml/min) or hemodialysis.
• patients with a history of hepatic impairment.
• chronic pain condition that required daily opioid dependence.

Operative:

• conversion to laparotomy.