Patient Presented With Acute Abdomen Clinical Trial
Official title:
Conventional VS Enhanced Recovery After Surgery Protocols in Emergency GIT Surgery
Although the ERAS program is widely used in elective procedures in many surgical subspecialties, the place of this program in emergency surgery remains uncertain probably because of the significant challenges in applying all ERAS pathways in the emergency setting. Nevertheless, the ERAS program is often modified in elective procedures on an individual and/ or institutional basis and thus may also have a role in the emergency setting albeit in a modified form.
The cases will be randomized simply into two groups, Group (A) for conventional care and
Group (B) for ERAS. Random assignment of intervention will be done after subjects have been
assessed for eligibility and recruited. The sealed envelope method will be used for
randomization.
Both groups will have pre-operative ryle inserted, urinary catheter applied, Tracheal
intubation and with General anesthesia, exploration laparotomy Group (A) Fatsing for at least
6 hours pre-operative, No restriction of IV fluids and traditional analgesia including
opiates. Post-operative Ambulation-as per patients' own request, Removal of urinary catheter
when patient ambulates, patient will keep fasting for 3 days postoperative, oral fluids for 3
days, semi-solid for another 3 days and then can take full diet, removal of nasogastric tube
just before starting oral fluids, drain removal just before discharge.
Group (B) Preoperative information, education and counselling, If possible, Clear fluids are
allowed up to 2 h and solids up to 6 h prior to induction of anaesthesia, Short acting
anesthetic agents,avoid opioid agents, Post operative nausea and vomiting prophylaxis,
Patient will wear well-fitting compression stockings and receive pharmacological prophylaxis
with LMWH. Encourage to mobilize out of bed after effect of general anesthesia has weaned
off, Chewing gum, oral magnesium and alvimopan can be started early postoperatively,
Initiation of feeding-Oral sips on day 1, step up day 2 onward, Removal of nasogastric
tube-immediately after surgery after aspirating the gastric content through nasogastric tube,
Removal of urinary catheter-after weaning from the effect of general anesthesia and drain
removal -anytime within 24 hours;drain will not be removed if fluid is bilious or pus.
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