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Title: Pain management, fluid therapy and thromboprophylaxis after pancreatoduodenectomy: a worldwide survey among surgeons.
Austin Authors: Groen, Jesse V;Henrar, Rutger B;Hanna Sawires, Randa G;AlEassa, Essa;Martini, Chris H;Bonsing, Bert A;Vahrmeijer, Alexander L;Besselink, Marc G;Pecorelli, Nicolo;Hackert, Thilo;Ishizawa, Takeaki;Miller, Timothy;Mungroop, Timothy H;Samra, Jaswinder;Sauvanet, Alain;Adham, Mustapha;Demartines, Nicolas;Christophi, Christopher ;Morris-Stiff, Gareth;Mieog, J Sven D
Affiliation: Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
Department of Visceral Surgery, University Hospital Lausanne (CHUV), University of Lausanne, Lausanne, Switzerland
Department of Anaesthesiology, Duke University School of Medicine, Durnham, USA
Hepato-Biliary Pancreatic Surgery, Digestive Diseases and Surgery, Cleveland Clinic Institute, Cleveland, USA
Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
Department of Anaesthesiology, Leiden University Medical Center, Leiden, the Netherlands
Department of Surgery, Amsterdam UMC, Amsterdam, the Netherlands
Department of Surgery, University of Heidelberg, Heidelberg, Germany
Hepato-Biliary-Pancreatic Surgery Division, University of Tokyo, Tokyo, Japan
Upper GI Surgical Unit, Department of Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, Australia
Surgery (University of Melbourne)
Department of Digestive Surgery and Transplantation, Beaujon Hospital, Clichy, France
Department of Digestive Surgery, Hopital Edouard Herriot, Lyon, France
Issue Date: 24-Sep-2021 2021-09-24
Publication information: HPB 2021; online first: 24 September
Abstract: The aim of this survey was to assess practices regarding pain management, fluid therapy and thromboprophylaxis in patients undergoing pancreatoduodenectomy on a global basis. This survey study among surgeons from eight (inter)national scientific societies was performed according to the CHERRIES guideline. Overall, 236 surgeons completed the survey. ERAS protocols are used by 61% of surgeons and respectively 82%, 93%, 57% believed there is a relationship between pain management, fluid therapy, and thromboprophylaxis and clinical outcomes. Epidural analgesia (50%) was most popular followed by intravenous morphine (24%). A restrictive fluid therapy was used by 58% of surgeons. Chemical thromboprophylaxis was used by 88% of surgeons. Variations were observed between continents, most interesting being the choice for analgesic technique (transversus abdominis plane block was popular in North America), restrictive fluid therapy (little use in Asia and Oceania) and duration of chemical thromboprophylaxis (large variation). The results of this international survey showed that only 61% of surgeons practice ERAS protocols. Although the majority of surgeons presume a relationship between pain management, fluid therapy and thromboprophylaxis and clinical outcomes, variations in practices were observed. Additional studies are needed to further optimize, standardize and implement ERAS protocols after pancreatic surgery.
DOI: 10.1016/j.hpb.2021.09.006
Journal: HPB
PubMed URL: 34629261
Type: Journal Article
Appears in Collections:Journal articles

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