Impact of General Anesthesia v/s Spinal Anesthesia on Enhanced Recovery After Surgery (ERAS) Parameters in Intestinal Stoma Reversal: A Randomised Control Trial

Temporary intestinal stomas are commonly created in emergency and elective surgeries to divert intestinal contents from distal anastomoses site or after resection of a diseased bowel segment. They however increase the morbidity of a patient, impacting the life of a patient socially and psychologically. A timely and planned early stoma reversal can reduce various stoma related complications (up to 71%) like parastomal leakage, dermatitis, prolapse, retraction, dehydration, electrolyte imbalance and acute kidney injury, and occasionally requirement of parenteral nutrition. However these patients are often subject to long waiting periods for want of availability of a slot under general anaesthesia. More importantly, quite some of these patients with temporary stoma have poor general condition and comorbidity prohibiting a timely stoma closure. Closing intestinal stomas under regional anaesthesia could have partially addressed the issue. But studies exploring the feasibility of the stoma closure under spinal/ regional anaesthesia are limited to a few case series. There is a dearth of good quality literature having a head to head comparison ileostomy closure done under spinal anaesthesia vs those done under the more commonly employed general anaesthesia. ERAS was brought into picture considering the physiological changes in metabolism during the perioperative period and implemented to cut short the phase of perioperative stress and early recovery of the patient, with minimal postoperative complications ERAS is an evidence based multidisciplinary approach that has outweighed many conventional approaches to achieve early discharge of the patient in various elective and emergency surgeries like Colorectal, Gastric, Hepatobiliary, Breast and Pre pyloric perforation Dr Henrik Kehlet, a Danish Colorectal Surgeon first proposed the concept of Fast track surgery in order to decrease the surgical stress, the different components being broadly classified into Preoperative, intra-operative and post-operative care. ERAS can potentially be implemented in Intestinal Stoma Reversal Surgery, and is worth demanding of a Day Care Surgery, with Spinal Anaesthesia expecting to be an adjunct in fastening the recovery.

Preoperative Preoperative counselling Avoid prolong fasting Carbohydrate loading No preanaesthetic medication Antibiotic prophylaxis Thromboprophylaxis

Intraoperative Short acting anaesthetics. Minimaly invasive surgery Goal directed fluid therapy Temperature homeostasis

Postoperative Prevention of PONV Early removal of catheter and drain. Early enteral nutrition Early mobilization

STUDY OBJECTIVES PRIMARY OBJECTIVE To study the return of bowel function Secondary Objective Return of functional parameters Complication rates Post operative pain assessment Surgeon and patient comfort