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Improved Outcomes in Colon and Rectal Surgery part 9

Improved Outcomes in Colon and Rectal Surgery part 9. Written by many of the worlds leading colorectal surgeons, this evidence-based text investigates the risks and benefits of colorectal surgeries. By using clinical pathways, algorithms, and case discussions, the authors identify the best practices for patient safety and positive outcomes to ensure that physicians correctly recognize potential problems and carefully manage complications | improved outcomes in colon and rectal surgery a narcotic-sparing role. In a study of over 1 000 patients the addition of ketorolac to standard intravenous morphine significantly reduced the overall postoperative morphine requirements and lowered side effects both directly attributable to the narcotic mental status pulmonary as well as gastrointestinal function ileus nausea vomiting . 4 The anti-inflammatory action of these agents especially when used on a set schedule may be most beneficial for the pain associated with the musculoskeletal trauma of the incision allowing a significant reduction in pain without the untoward side effects associated with narcotic use. Pain following anorectal surgery can be quite debilitating and is often cited by patients as a primary deterrent toward undergoing needed procedures such as hemorrhoidectomy. 5 In addition to the local trauma associated with resection pain following anal canal procedures is often attributed to anal sphincter spasm. This in combination with the constipation and hard stools often associated with narcotic use results in additional pain and suffering once return of bowel function commences. As in the laparotomy literature recent trials have shown a marked decrease in the narcotic requirements using ketorolac and other NSAIDs periopera-tively for anorectal surgery. 6 Local anesthesia which has been commonly employed in the field of anorectal surgery has recently been expanded to continued use postoperatively following abdominal procedures. As a primary modality during anorectal procedures it has been shown to be effective and safe with or without the addition of deep intravenous sedation and provides the additional benefit of less time in the recovery room. 7 8 As an adjunct following laparotomy a local anesthetic agent is applied via continuous infusion to the midline wound through a set of subcutaneous catheters placed at the time of surgery. 9 Despite mixed results some prospective data does demonstrate a .