RESUMEN
BACKGROUND: We hypothesized that administration of IV acetaminophen alone would reduce the opioid consumption in post-operative colorectal surgery and reduce the side effects of narcotics. METHODS: Patients were randomized to receive either IV acetaminophen or placebo in addition to opioid PCA. Primary endpoints evaluated were opioid consumption and pain visual analogue scale score (PVASS) during first 48 h post-operatively. Secondary endpoints evaluated were time of return of GI function (ROGIF), time to diet ordered (TTDO), length of hospital stay (LOHS), and occurrence of ileus. RESULTS: 105 patients were enrolled and 97 remained in the study after exclusion (control group n = 50; study group n = 47). Mean ± SEs of opioid consumption in the study group was 21.5 ± 1.8 mg of morphine equivalent (ME) and 35.0 ± 3.3 mg ME at 24 and 48 h, respectively, versus 36.4 ± 4.1 mg ME and 59.7 ± 6.7 mg ME in the control group (p = 0.002 and 0.002). PVASS levels were lower in the study group at all intervals at 3, 8, 24, and 48 h (p = 0.02, 0.006, < 0.01, and 0.02). ROGIF, TTDO, and LOHS were also found to be lower in the study group (p ≤ 0.01, < 0.01, and 0.002). The rate of ileus was reduced by using IV acetaminophen (22% vs 2.1%; p = 0.004). CONCLUSIONS: IV acetaminophen helps to reduce opioid consumption for patients undergoing colorectal surgery. Additionally, there appears to be a shortened length of hospital stay, better pain control, reduced time to return of bowel function, and lower rate of post-operative ileus in patients receiving IV acetaminophen.
Asunto(s)
Acetaminofén/administración & dosificación , Analgésicos no Narcóticos/administración & dosificación , Analgésicos Opioides/administración & dosificación , Colectomía , Colostomía , Dolor Postoperatorio/tratamiento farmacológico , Proctectomía , Acetaminofén/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Analgésicos no Narcóticos/uso terapéutico , Analgésicos Opioides/uso terapéutico , Método Doble Ciego , Femenino , Humanos , Ileus/inducido químicamente , Ileus/prevención & control , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Dolor Postoperatorio/diagnóstico , Complicaciones Posoperatorias/inducido químicamente , Complicaciones Posoperatorias/prevención & control , Estudios Prospectivos , Resultado del TratamientoRESUMEN
BACKGROUND AND OBJECTIVES: Osler-Weber-Rendu is a hereditary disease characterized by telangiectasias, arteriovenous malformations, and aneurysms involving the cutaneous, gastrointestinal, pulmonary, and central nervous systems. This report describes a combinatorial approach using laparoscopic and intraoperative endoscopy to perform a partial gastric resection of bleeding arteriovenous malformations. METHODS: A 70-year-old female with a history of bleeding from Osler-Weber-Rendu disease presented to the emergency department complaining of hematemesis. Her vital signs were unstable, and she was immediately resuscitated with intravenous fluids and transfusions. A combined laparoscopic and intraoperative endoscopic approach to a partial gastric resection was planned. Intraoperatively, a single lesion was identified along the posterior aspect of the greater curvature of the stomach by using endoscopy. The blood supply was taken down with a Ligasure and gastric resection with a 60-mm Echelon stapler. RESULTS: The pathology report confirmed the complete resection of the arteriovenous malformations. The patient recovered well and was discharged home several days later without any pain complaints. CONCLUSIONS: Little has been written about the medical treatment of Osler-Weber-Rendu arteriovenous malformations, let alone surgical treatment. A combinatorial laparoscopic and intraoperative endoscopic approach to gastric resection allows both minimization of the gastric resection and the complete identification and removal of the arteriovenous malformations.