Recently, Vinmec Da Nang International Hospital has successfully performed surgery for right colon cancer for a 75-year-old man with a large tumor. This is a case managed by the Early Rehabilitation Care Program (ERAS) and applying postoperative analgesia by means of erector vertebral plane anesthesia (ESP) - an advanced postoperative analgesia method and most effective today; helped the patient recover quickly and be discharged from the hospital early.
After displaying symptoms of right iliac fossa stomach pain, loose stools, and intermittent constipation for some time, Mr. Pham Chach (75, from Quang Binh) was found to have right colon cancer/gallstones. But he believed he had a typical stomach ache, so he bought self-medication on the advice of a friend. The problem does not improve after treatment and actually worsens over time. Mr. Chach opted to receive treatment at Vinmec Da Nang International Hospital after becoming concerned about his health and gathering information. Doctor Duong Xuan Loc - Gastroenterology physician and members of Team ERAS, gave Mr. Cach an explanation of the facility's treatment options, post-operative recovery capabilities, and patient care services.
The fact that Mr. Chach is an elderly, has chronic cholecystitis brought on by stones, and had previously undergone an internal appendectomy surgery three months prior makes his case one of the more challenging ones, according to Dr. Loc. In addition, the tumor is huge, and if the previous surgical technique (open surgery) is used, the patient would need to make a lengthy incision, which will result in significant discomfort after surgery, a protracted recovery, and a high risk of pneumonia in the future. The surgical team decided on "Laparoscopic right colectomy with lymphadenectomy and use of the ERAS protocol" after carefully considering every factor.
With the help of numerous specializations, including surgery, anesthesiology, nutrition, clinical pharmacy, rehabilitation, psychiatry, and nursing care, patients can avoid making large incisions and prepare for surgery in the best possible ways before, during, and after the procedure. After four days of treatment, patients are able to eat and drink right away, exercise right away, have good pain relief, and are then discharged from the hospital. A patient's unique holistic care plan is created to lessen the effects of surgery on them, including stress and organ dysfunction. Therefore, patients can recover quickly, soon after surgery.
Doctor Binh, Head of Surgery - Anesthesiology, Vinmec Da Nang International Hospital also shared: In this case, Vinmec Da Nang performed postoperative pain relief by means of anesthesia of the erector spinae plane (ESP) under ultrasound guidance - is the most advanced and effective method of postoperative pain relief today. The patient will also be monitored by an early postoperative recovery care (ERAS) program following surgery. According to this program, patients will have optimal nutrition (without prolonged fasting, drink 200ml of apple juice 2 hours before surgery), and only a single dose of prophylactic antibiotics before surgery. Apply an anesthetic - multimodal pain reliever regimen without opiates (Opioids). Only 2 hours after surgery, the patient was able to drink water, milk, eat porridge and sit up and do gentle rehabilitation exercises in bed for 4 hours after surgery. One day following surgery, the patient experienced very little pain, was able to keep normal eating and hygiene habits, and was given dietary and exercise recommendations by a nutritionist and rehabilitation specialist appropriate to his physical condition. The patient was able to walk and urinate regularly on the 3rd day after surgery, allowing for hospital discharge. He was thus able to leave the hospital only three days following the operation and after a four-day stay overall.
Before leaving the hospital, Mr. Dung and his family expressed their sincere gratitude to the Vinmec Da Nang International Hospital’s medical staff. He was really concerned and terrified before the surgery that he would be in pain and have to stay in the hospital for a very long time. To his astonishment, everything following the procedure was entirely different from what he had anticipated. He is currently eating well and his health is improving swiftly.
Early Rehabilitation After Surgery (ERAS) programs offer pre-, peri-, and postoperative care for patients. Prior to surgery, patients are explicitly informed about ERAS so they can take part in the procedure safely and receive after care. The patient will receive the best nutrition possible while following the usual anesthetic-analgesia regimen. The ERAS program aids patients in laparoscopic colorectal surgery by preventing the need for fasting, enemas, drainage during surgery, fluid optimization to prevent water-electrolyte disturbances, pain relief without the use of morphine, and the use of more than one dose of prophylactic antibiotics to prevent side effects. After surgery, the patient consumed water, milk, soft foods, and sat up after two hours during the day. On the first day after surgery, the patient can give up fluids and eat raw, practice walking for 4-6 hours. ERAS also lessens the likelihood of complications, shortens hospital stays, and lowers the chance of re-hospitalization.
The erector spinae plane (ESP) under Ultrasound guidance is a technique in which doctors insert a catheter under the vertebral column next to the spine from the back to suppress pain signals before it is transmitted to the spine. ESP is a method of local anesthetic to block pain signals before reaching the spinal cord and brain, thereby avoiding postoperative pain. This is a modern, uncomplicated method that can shorten the time of active recovery, eliminate the risk of postoperative pain and chronic pain for 96% of patients.
Below are some pictures of patients recovering under the ERAS program at Vinmec Da Nang International Hospital.
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