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Relieving Pain in Colorectal Surgery

Relieving Pain in Colorectal Surgery

Researchers have developed enhanced recovery pathways (ERP) to improve outcomes and reduce readmissions in colorectal surgery patients. “ERP protocols use a set of standardized pre- and postoperative orders,” explains Conor P. Delaney, MD, PhD, FACS, FASCRS. “Research clearly shows that these protocols can help speed recovery and improve outcomes.” ERP protocols emphasize early mobilization after surgery, optimal analgesia, and control of intravenous fluid volumes. Patients are also encouraged to eat the day after their procedure rather than wait several days. To further improve outcomes, it has been hypothesized that adding a transversus abdominis plane (TAP) block to ERP protocols may allow patients to bypass or reduce narcotics use after surgery. TAP blocks are usually administered with ultrasound guidance, but a laparoscopic technique has been developed in which regional analgesia is injected into the abdominal wall between the oblique muscles and the transversus abdominis. “The TAP block can be given after surgery to reduce pain in the operative area,” says Dr. Delaney. “While narcotics help alleviate pain, they can slow recovery. The TAP block is different in that it wears off in time for patients to avoid the worst pain that typically occurs immediately after surgery.” Encouraging Data In a study of 100 patients published in the Journal of the American College of Surgeons, Dr. Delaney and colleagues tested the use of a laparoscopically administered TAP block as part of ERP protocols. After the block, patients were also given intravenous painkillers. According to findings, the average hospital stay after surgery dropped to less than 2.5 days for those receiving the TAP block. This was significantly lower than the 3.7 days...
Functional Outcomes After Treatment for Prostate Cancer

Functional Outcomes After Treatment for Prostate Cancer

Studies have shown that patients with localized prostate cancer have favorable long-term overall survival rates and cancer-specific survival regardless of the treatment that is selected. Few prospective, randomized trials have looked at differences in survival outcomes between radical prostatectomy and external-beam radiation therapy. As a result, the decision-making process for clinicians and patients shifts. Treatment decisions become more about predicting functional outcome than about survival. Investigations with short-term and intermediate follow-up have identified incremental differences in functional outcome between patients undergoing prostatectomy and those receiving radiotherapy. While much is known about what happens the first several years after treatment, less is known about outcomes extending beyond 5 years. “Most patients live 10 to 20 years after treatment,” says David F. Penson, MD, MPH. “A careful evaluation of long-term functional outcomes can help us better understand the experience of men living with a diagnosis of prostate cancer.” Long-Term Function of Prostatectomy Vs Radiotherapy In a study published in the New England Journal of Medicine, Dr. Penson and colleagues prospectively compared urinary, sexual, and bowel function in 1,655 men with clinically localized prostate cancer, 1,164 of whom underwent prostatectomy, while 491 received radiotherapy. The study team also examined the extent to which men were bothered by declines in function at 15 years after prostatectomy or radiotherapy. Most of the men were in their 60s when they first received treatment. According to the results, men receiving prostatectomy were significantly more likely than those in the radiotherapy group to report urinary leakage and erectile dysfunction at 2 and 5 years after treatment. However, these problems increased in both groups over time, including 15...
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