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All Journal Indonesian Journal of Anesthesiology and Reanimation (IJAR) Jurnal Komplikasi Anestesi
Firdaus, Khildan Miftahul
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Medicine & Pharmacology

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Preliminary Survey in preparation for the implementation of ERAS at Dr Soetomo Hospital Veterini, Anna; Firdaus, Khildan Miftahul; Semedi, Bambang Pujo; Putri, Herdiani Sulistyo; Fitritati, Mariza; Mutiar, Airi
Jurnal Komplikasi Anestesi Vol 11 No 1 (2023): Volume 11 Number 1 (2023)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v11i1.9952

Abstract

Background Medical science has developed rapidly. One of them is ERAS (Enhanced Recovery After Surgery) which is a multidisciplinary team development pathway for perioperative methods that offer a variety of benefits. Some of the advantages of the ERAS method are speeding up the post-operative recovery period, economic benefits, and shortening the Length of Stay (LOS) by minimizing surgical stress so that the patient quickly returns to a normal physiological state. Objective This study aims to analyze the readiness of the team that will support the ERAS application at General Academic Hospital (RSUD) Dr Soetomo. Methods This is an observational analytic study with a cross-sectional design using a questionnaire. Patient baseline data were taken from the examination at the anesthesiology outpatient clinic. Assessment for patient understanding was carried out directly after a brief explanation of ERAS method by the researcher. The patient's level of understanding was assessed by two investigators and rated on a scale of 1 to 5. Primary data and assessment of understanding of doctors and medical personnel were filled in independently by research subjects on online forms and rated on a scale of 1 to 5. Data was collected from March 23 to April 14 2022, at RSUD Dr. Soetomo Surabaya. The analysis results are considered significant if the p-value is less than 0.05. The analysis was carried out using SPSS 19 software. Results Most patients planned to undergo surgery in the field of urology (82.9%), followed by caesarean section (14.6), and almost all patients or their families agreed to surgery using the ERAS method (95.1%). The medical team consists of 110 doctors from 4 areas of expertise, namely specialist doctors and residents in anesthesiology, urology surgery, obstetrics and gynecology, as well as orthopedics and traumatology. The health team consists of 56 personnel, namely anesthesiologists, surgeons, recovery room nurses, nutritionists and pharmacists. The majority (61%) of health workers had heard about ERAS and stated that ERAS was ready to be implemented at RSUD Dr. Soetomo (89%). Most doctors stated that ERAS was ready to be implemented at Dr. Soetomo and its human resources and facilities are considered qualified. Conclusion The ERAS method at RSUD Dr. Soetomo is considered quite ready to start, especially the Obsgyn study program, which is supposed to have an excellent level of understanding of ERAS and is enthusiastic to begin immediately. The patient group can be said to understand and accept the ERAS method well as a perioperative method for handling their cases.
Ultrasound-Guided Peripheral Nerve Block as Post-Operative Management of Lower Abdominal Surgery in Ksatria Airlangga Floating Hospital Setjaputra, Vina Lidya; Susianto , Steven Christian; Silitonga , Jessica Deborah; Kusumaningtyas , Maya Hapsari; I Putu Agni Rangga Githa; Atmaja, Robbi Tri; Wardhana, Burhan Mahendra Kusuma; Bandem, I Ketut Mega Purnayasa; Firdaus, Khildan Miftahul; Harianto, Agus
Indonesian Journal of Anesthesiology and Reanimation Vol. 6 No. 2 (2024): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V6I22024.99-105

Abstract

Introduction: Enhanced Recovery After Surgery (ERAS) implementation in remote areas by operating hospital ships is immensely helpful due to high patient turnover, reducing costs, and minimizing the effects of surgical stress. Utilization of regional anesthetics, namely ultrasound-guided Transversus Abdominis Plane (TAP) block or Quadratus Lumborum (QL) block, is applicable and beneficial in this setting. Objective: Due to the limited time, facilities, and health personnel available in floating hospital services surgery, several adjustments in anesthetic methods are required to rapidly return patients to their preoperative physiologic state. Therefore, we wrote this case report. Case Series: We presented case series of lower abdominal surgery performed in Ksatria Airlangga Floating Hospital with the implementation of peripheral nerve blocks as one of the ERAS protocols in one of the remote islands in Indonesia, Gili Iyang Island. Two patients underwent TAP blocks, while the remaining two received QL Blocks. A peripheral nerve block was performed under ultrasound guidance and a 20-mL injection of 0.25% levobupivacaine to QL muscle or TAP. During the observation, we found Visual Analogue Score (VAS) of 1-2 after surgery, no post-operative sedation needed, only 1 patient experienced nausea without vomiting, and the length of health facility stay were less than 3 days. Nearly all of our patients who underwent lower abdomen surgery got benefits from the application of peripheral nerve block. Because there was no opioid consumption in our cases, the risk of unwanted effect of opioids like postoperative nausea and vomiting, were also decreased. Conclusion: Peripheral nerve block, as mentioned TAP Block and QL Block, has emerged as a promising alternative to prevent and manage post-operative pain in remote medicine settings, namely Ksatria Airlangga Floating Hospital, particularly in areas with few medical facilities.
Co-Authors AGUS HARIANTO Atmaja, Robbi Tri Bandem, I Ketut Mega Purnayasa Fitritati, Mariza Herdiani Sulistyo Putri I Putu Agni Rangga Githa Kusumaningtyas , Maya Hapsari Mutiar, Airi Semedi, Bambang Pujo Setjaputra, Vina Lidya Silitonga , Jessica Deborah Susianto , Steven Christian Veterini, Anna Wardhana, Burhan Mahendra Kusuma