Impact of Abdominal Drains on the ERAS Pathway in Peptic Perforation (TUBELESS)
Perforated Peptic Ulcer, Fast Track Surgery, Perforated Bowel
About this trial
This is an interventional treatment trial for Perforated Peptic Ulcer focused on measuring ERAS, Emergency surgery, fast track surgery, perioperative care, Enhanced recovery after surgery
Eligibility Criteria
Inclusion Criteria:
- Patient of peptic ulcer perforation peritonitis ( when confirmed intraoperatively)
- Perforation of size less than or equal to 1 cm.
- Patient age more than 18 years age
- American society of anesthesiologists score of I or II
Exclusion Criteria:
- Refractory septic shock at presentation
- Known Chronic kidney disease (CKD)/Chronic liver disease (CLD) patients
- Pregnant patients
- History of chronic steroid abuse
- INTRAOPERATIVELY detected coexistent bleeding peptic ulcer, perforation requiring operation other than omental patch repair, spontaneously sealed peptic perforation, malignant perforation
- Patient requiring positive pressure ventilatory support post-operatively for more than 6 hours.
- Patient refusing consent.
- Co-existent neurological or psychiatric illness or unable to understand the study
Sites / Locations
- All India Institute of Medical Sciences,Recruiting
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
ERAS protocol without the use of of abdominal drain in the perforated peptic ulcer patient
ERAS protocol with the use of of abdominal drain in the perforated peptic ulcer patient
Tracheal intubation. Short acting anesthetic agents,avoid opioid agents . Omental patch repair without placement of sub hepatic drain. Bilateral Transverse abdominis plane block/ Rectus sheath block immediately after surgery. Abdominal drain will not be placed Post operative nausea and vomiting prophylaxis. Encourage to mobilize out of bed after effect of general anesthesia has weaned off. 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. Avoid opioid analgesics.
Tracheal intubation. Short acting anesthetic agents, avoid opioid agents. Omental patch repair with placement of sub hepatic drain. Bilateral Transverse abdominis plane block/ Rectus sheath block immediately after surgery. Abdominal Drains will be placed and removed at anytime within 24 hrs and to not remove if the output is bilious or pus. Post operative nausea and vomiting prophylaxis. Encourage to mobilize out of bed after effect of general anesthesia has weaned off. 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. Placing Sub hepatic drain intraoperatively. Avoid opioid analgesics.