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1Department of Colorectal Surgery, Hansol Hospital, Seoul, Korea
2Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
© 2024 The Korean Society of Coloproctology
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Conflict of interest
No potential conflict of interest relevant to this article was reported.
Funding
None.
Author contributions
Conceptualization: CSL, YSL, JHB, SRH, DSL; Data curation: IKK, CSL; Formal analysis: JSK, IKK, CSL; Investigation: CSL; Methodology: IKK, CSL; Project administration: IKL, YSL, JHB, SRH, DSL; Visualization: IKL, YSL; Writing–original draft: JSK, IKK, CSL; Writing–review & editing: JHB, SRH, DSL, IKL, YSL. All authors read and approved the final manuscript.
Outcome | Group A (n=67) | Group B (n=41) | P-value |
---|---|---|---|
Operative time (min) | 64.7±24.1 | 53.3±21.7 | 0.015 |
Postoperative opioid consumption | |||
Pethidine (mg) | 12.3±48.1 | 39.0±69.1 | <0.001 |
Oxycodone (mg) | 0.2±1.1 | 0.3±1.2 | 0.812 |
Morphine milligram equivalents | 9.7±9.5 | 21.2±8.8 | <0.001 |
Median daily pain score (VAS) | |||
Postoperative day 1 | 2.6±1.3 | 3.2±1.2 | 0.013 |
Postoperative day 2 | 2.9±0.7 | 2.2±0.9 | <0.001 |
Postoperative hospital stay (day) | 2.3±1.5 | 4.1±1.5 | <0.001 |
Postoperative complication | 7 (10.4) | 6 (14.7) | 0.552 |
Ileus | 6 (9.0) | 5 (12.2) | 0.589 |
Bleeding | 1 (1.5) | 1 (2.4) | 0.723 |
Surgical site infection | 0 (0) | 0 (0) | 0.506 |
Severe complicationa | 0 (0) | 0 (0) | - |
Reoperation | 0 (0) | 0 (0) | - |
Readmission within 30 days | 7 (10.4) | 3 (7.3) | 0.739 |
Morality within 30 days | 0 (0) | 0 (0) | - |
Values are presented as mean±standard deviation or number (%). Group A, multimodal pain management group. Group B, conventional management group.
VAS, visual analog scale.
aClavien-Dindo classification ≥IIIa (requiring surgical, endoscopic, or radiological intervention not under radiological intervention).
Characteristic | Multimodal pain management | Standardized management |
---|---|---|
Perioperative care | Per standardized with multimodal analgesic management | Per standardized management |
Antimicrobial prophylaxis | Single dose cefoxitin 1 g was given at induction | |
Patient-controlled analgesia system | All patients until the morning after surgery | |
Liquid diet | 4 hr after surgery | |
Ambulation | After surgery | |
Soft diet | 1st day after surgery | |
Multimodal analgesic approach | Yes | No |
Oral analgesia | Before and after surgery | First day after surgery |
Surgical and ultrasound-guided TAP block | Yes | No |
Operative period | August 2019–March 2020 | April 2017–August 2019 |
No. of patients | 67 | 41 |
Wound closure | Purse-string skin closure | |
Inclusion criteria | Rectal cancer, elective surgery | |
Exclusion criteria | Combined operation with other organs |
Characteristic | Group A (n=67) | Group B (n=41) | P-value |
---|---|---|---|
Age (yr) | 59.0±12.9 | 61.3±12.8 | 0.375 |
Male sex | 38 (56.7) | 27 (65.9) | 0.347 |
Body mass index (kg/m2) | 22.3±4.2 | 23.7±3.2 | 0.068 |
ASA classification | 0.486 | ||
I | 10 (14.9) | 4 (9.8) | |
II | 53 (79.1) | 36 (87.8) | |
III | 4 (6.0) | 1 (2.4) | |
Diabetes mellitus | 3 (4.5) | 11 (26.8) | 0.172 |
Smoking | 3 (4.5) | 7 (17.1) | 0.739 |
Outcome | Group A (n=67) | Group B (n=41) | P-value |
---|---|---|---|
Operative time (min) | 64.7±24.1 | 53.3±21.7 | 0.015 |
Postoperative opioid consumption | |||
Pethidine (mg) | 12.3±48.1 | 39.0±69.1 | <0.001 |
Oxycodone (mg) | 0.2±1.1 | 0.3±1.2 | 0.812 |
Morphine milligram equivalents | 9.7±9.5 | 21.2±8.8 | <0.001 |
Median daily pain score (VAS) | |||
Postoperative day 1 | 2.6±1.3 | 3.2±1.2 | 0.013 |
Postoperative day 2 | 2.9±0.7 | 2.2±0.9 | <0.001 |
Postoperative hospital stay (day) | 2.3±1.5 | 4.1±1.5 | <0.001 |
Postoperative complication | 7 (10.4) | 6 (14.7) | 0.552 |
Ileus | 6 (9.0) | 5 (12.2) | 0.589 |
Bleeding | 1 (1.5) | 1 (2.4) | 0.723 |
Surgical site infection | 0 (0) | 0 (0) | 0.506 |
Severe complication |
0 (0) | 0 (0) | - |
Reoperation | 0 (0) | 0 (0) | - |
Readmission within 30 days | 7 (10.4) | 3 (7.3) | 0.739 |
Morality within 30 days | 0 (0) | 0 (0) | - |
TAP, transversus abdominis plane.
Values are presented as mean±standard deviation or number (%). Group A, multimodal pain management group. Group B, conventional management group. ASA, American Society of Anesthesiologists.
Values are presented as mean±standard deviation or number (%). Group A, multimodal pain management group. Group B, conventional management group. VAS, visual analog scale. Clavien-Dindo classification ≥IIIa (requiring surgical, endoscopic, or radiological intervention not under radiological intervention).