Hizbullah Jan, Attaullah Khan, Anayat, Mah Munir Khan, Sayed Mohammad Hamid.
Effectiveness of fast tract surgery protocols in patients undergoing appendicectomy. a pragmatic trial.
Pak J Surg Jan ;35(1):30-5.

Objective: To determine the effectiveness of fast track surgery protocols in patients undergoing appendicectomy both open and laparoscopically. Materials and methods: This study was conducted in surgical department of Khyber teaching hospital Peshawar from January 2018 to June 2018. Total 154 patients were included in this study. They were randomized in two groups, by lottery method. Group-I (interventional) and group-II (controlled) group. All patients both male and female with age range of 18 to 60 years, who presented with acute appendicitis without any complications, were included. While those with co-morbidities like diabetes mellitus and ischemic heart disease were excluded. Patients were clinically evaluated aft er informed consent and kept nil by mouth 6 hours before surgery, following a glass of fluid containing sugar. Aft er surgery they were allowed orally within 4-6 hours and mobilized within 6 hours of surgery as well. Injection Ondansetron for controlling post operative nausea and vomiting. Infusion paracetamol alone in majority of the patients while in some of the cases paracetamol with non-steroidal anti-inflammatory drugs in combination were used to control post-operative analgesia. All patients were reviewed on 9th -10th post-operative day for stitch removal and any other possible complication. Results: A total of 154 patients were enrolled in this study. Mean age was 22.4 ±6.31 years. Among them 66(43.14%) were female and 88(56.86%) male. Mean duration for Pre-operative fasting was 9.78 ± 4.62. Mean durations for first fluid intake were 8.38 ± 6.31 hours and first solid intake 15.53 ±9.47 hours. Mean duration for first mobilization was of 13.56± 8.39 hours. Effective analgesia was obtained with only paracetamol infusion in 81.9% of patients while combined analgesia using ketorolac and paracetamol infusion in 18.1% of patients. Post operative nausea and vomiting were effectively controlled with injection Ondansetron. 69.74% of patients were having no post-operative complications. In rest of the patients 10.53% were having wound site pain, 3.95% wound infection and 15.78% post-operative nausea and vomiting. Mean hospital stay was 1.3days (p-value <0.001). Conclusion: Fast track surgery protocols enhances post operative recovery, shortens hospital stay without increasing post-operative complications. Further studies are needed in other surgical diseases, to see the effects of fast track protocols.

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