Since the concept of fast track surgery (also known as enhanced recovery after surgery (ERAS)) was first introduced by Professor Kehlet in 1997, it has been 18 years of clinical practice. Significant progressions have been made in different fields of surgery, generally, in reducing the surgical stress, reducing the postoperative complications, and shortening the length of hospital stay. It has also been over ten years since the first research of ERAS in China. However, there are still some difficulties and obstacles in clinical applications, especially from the traditional habit. Thus, future studies of surgical stress and the regularity of metabolism are needed. The existing evidence of researches on ERAS should be translated into clinical application. Therefore, the aim of free-pain and no risk surgery will be achieved.
China ; Humans ; Length of Stay ; Postoperative Complications ; prevention & control ; Postoperative Period

Background: Gastric cancer surgery is major surgery and often encountered in surgical. Objectives: To assess the efficacy and the side effect of postoperative patient \ufffd?controlled epidural analgesia (PCEA) with bupivacaine \ufffd?fentanyl after gastrectomy. Subjects and method:A prospective trial was conducted on 30 patients with gastrectomy because of cancer. Epidural catheter was inserted at level of D7-D9. Postoperative pain relief using PCEA with bupivacaine 0,125% - fentanyl 2\u03bcg/ml: 2ml bolus every 10 min, with basal infusion 2ml/h. VAS during normal tidal ventilation and following cough, the side effects were monitored during 48 hour period. Results: VAS decreased from 6,4 \xb1 1,4 to 2,6 \xb1 0,7, p<0,01 after 15 min. 90% patients had VAS under 2,5 after 1 hour and 100% reached VAS under 2,5 after 8 hours during normal tidal ventilation and following cough as well. Incidence of urinary retention, nausea and pruritus were 13,3; 3,3; and 3,3% respectively. Conclusion: PCEA provided a effective pain control after gastrectomy during normal tidal ventilation and following cough. The side effects remained unusual and minor.
Stomach Neoplasms/ surgery ; Bupivacaine ; Fentanyl ; Pain ; Postoperative/ prevention & ; control ;

Humans ; Preoperative Exercise ; Preoperative Care ; Postoperative Complications/prevention & control*

Enhanced recovery after surgery is a multimodal perioperative strategy according to the evidence-based medicine and multidisciplinary collaboration, aiming to improve the restoration of functional capacity after surgery by reducing surgical stress, optimal control of pain, early oral diet and early mobilization. Compared with other sub-specialty in general surgery, pancreatic surgery is characterized by complex disease, highly difficult procedure and more postoperative complications. Accordingly, pancreatic surgery shares a slow development in enhanced recovery after surgery. In this review, the feasibility, safety, application progress, prospect and controversy of enhanced recovery after surgery in pancreatic surgery are discussed.
Humans ; Pancreas ; surgery ; Pancreatic Diseases ; surgery ; Postoperative Complications ; prevention & control

Percutaneous vertebroplasty(PVP), among various other options,has become a mainstay in the management of osteoporotic compression vertebral fractures. The purpose of this article is to review complications arising from the procedure and describes methods to minimize them. Complications can be classified as mild,which may include a temporary increase in pain; transient hypotension and cement leakage in the intervertebral disc space or into paravertebral soft tissues, moderate, including infection; extravasation of cement into the foraminal or epidural space and severe such as cement leakage in the paravertebral veins, leading to pulmonary embolism, cardiac perforation, cerebral embolism or even death.
Humans ; Postoperative Complications ; etiology ; prevention & control ; Vertebroplasty ; adverse effects

In order to provide leads and ideas for the future clinical researches, overseas current randomized controlled trials on acupuncture for postoperative nausea and vomiting are studied in this article. Summarization is given on those overseas trials of the recent 20 years from aspects of effectiveness and advantages of acupuncture treatment, treatment methods and the best opportunity of treatment. The result indicates that the therapeutic effect of acupuncture on prevention and treatment of postoperative nausea and vomiting is basically approved by modern clinical researches. Further studies should be focused on the potential of influence on acupuncture effect by different types of anesthetics, durations of operation and sorts of surgery. Importance should also be attached on enhancing therapeutic effect of acupuncture treatment by applying proper differentiation of syndromes, as well as its benefit estimation on health economy.
Acupuncture Therapy ; Electroacupuncture ; Humans ; Postoperative Nausea and Vomiting ; prevention & control ; therapy

In recent years, the endoscopic treatment, which is based on the endoscopic mucosal resection and endoscopic submucosal dissection, has developed rapidly. Complication of the endoscopic therapy has been increasingly emphasized. When paying attention to the endoscopic technique innovation, we should also concern the standardization of endoscopic therapy and the prevention and treatment of its complications. Continuous improvement in the safety, practicality and efficacy of endoscopic therapy may translate into benefits for the patients.
Endoscopy, Gastrointestinal ; standards ; Humans ; Postoperative Complications ; prevention & control

OBJECTIVETo systematically evaluate the efficacy and safety of preoperative administration of cyclooxygenase-2 (COX-2) inhibitor on pain occurring with total knee arthroplasty (TKA).

METHODSWe electronically searched PubMed, Cochrane Library, EMBASE, CNKI, CBM, Wanfang data from inception to March 15, 2014 and manual searched journal of library collection to identify randomized controlled trials (RCTs) about preoperative administration of COX-2 inhibitor on pain occurring with TKA. The methodological quality of the included RCTs was assessed and the data were extracted according to the Cochrane Handbook 5.1.0. Meta-analysis was performed by using RevMan 5.2 software.

RESULTSA total of 6 RCTs involving 228 patients were included. The results of meta-analyses showed that: (1) Efficacy: The visual analog scale (VAS) of post-operation at 12-hour (WMD = -0.60, 95% CI -0.83 to -0.37, P < 0.000 01) and 24-hour (WMD = -0.74, 95% CI -1.29 to - 0.19, P = 0.008) was decreased when COX-2 inhibitor was used before operation. And compared with control group, experimental group decreased the modified numerical pain rating scale (MNPRS) at 24-hour (WMD = -0.50, 95% CI -0.70 to -0.30, P < 0.000 01), 48-hour (WMD = -0.55,95% CI -0.65 to -0.45,P < 0.000 01) under quiescent conditions, and the same result at 24-hour (WMD = -0.82, 95% CI -1.26 to -0.38, P <0.000 01), 48-hour (WMD = -0.71, 95% CI -0.82 to -0.60, P < 0.000 01) under active conditions. The morphine consumption postoperatively were fewer in experimental group at the first day (WMD = - 1.35, 95% CI -1.92 to -0.79, P < 0.000 01) and the second day (WMD = -1.60, 95% CI -2.68 to -0.52, P = 0.004). (2) Safety: COX-2 inhibitor could lessen the incidence of postoperative pruritus (RR = 0.35, 95% CI 0.15 to 0.84, P = 0.02), but not statistically decrease of nausea and vomiting (RR = 0.83, 95% CI 0.54 to 1.28, P = 0.40) and exhaustion (RR = 0.63, 95% CI 0.05 to 7.67, P = 0.72).

CONCLUSIONThe current evidence indicated that preoperative administration of COX-2inhibitor can effectively improve the effect of postoperative analgesia, reduce the consumption of morphine and lessen the incidence of pruritus. Due to the limited quantity of the included studies and the evidence with limited strength,further high-quality RCTs are needed to verify the aforementioned conclusion.

Arthroplasty, Replacement, Knee ; Cyclooxygenase 2 Inhibitors ; therapeutic use ; Humans ; Pain, Postoperative ; drug therapy ; Postoperative Complications ; prevention & control ; Pruritus ; prevention & control

Blood Loss, Surgical ; prevention & control ; Humans ; Intraoperative Complications ; prevention & control ; Postoperative Complications ; prevention & control ; Scoliosis ; surgery ; Superior Mesenteric Artery Syndrome ; prevention & control ; Surgical Wound Infection ; prevention & control

The risk of developing perioperative acute kidney injury (AKI) in elderly patients increases with age. The combined involvement of aging kidneys, coexisting multiple underlying chronic diseases, and increased exposure to potential renal stressors and nephrotoxic drugs or invasive procedures constitute susceptibility factors for AKI in elderly patients. The perioperative AKI in elderly patients undergoing noncardiac surgery has its own specific population characteristics, so it is necessary to further explore the characteristics of AKI in elderly patients in terms of epidemiology, clinical diagnosis, risk factors, and preventive and curative measures to provide meaningful clinical advice to improve prognosis, accelerate recovery, and reduce medical burden in elderly patients. Since AKI has the fastest-growing incidence in older patients and is associated with a worse prognosis, early detection, early diagnosis, and prevention of AKI are important for elderly patients in the perioperative period. Large, multicenter, randomized controlled clinical studies in elderly non-cardiac surgery patients with AKI can be conducted in the future, with the aim of providing the evidence to reduce of the incidence of AKI and to improve the prognosis of patients.
Humans ; Aged ; Acute Kidney Injury/prevention & control* ; Kidney ; Risk Factors ; Prognosis ; Incidence ; Postoperative Complications/prevention & control*