Peroral endoscopic myotomy: procedural complications and pain management for the perioperative clinician

Lopa Misra,1 Norio Fukami,2 Katarina Nikolic,1 Terrence L Trentman1 1Department of Anesthesiology, 2Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Phoenix, AZ, USA Abstract: Achalasia refers to the lack of smooth muscle relaxation of the distal esophagus. Althoug...

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Autores principales:	Misra L, Fukami N, Nikolic K, Trentman TL
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2017
Materias:	achalasia peroral endoscopic myotomy opioids adverse events postoperative pain Medical technology R855-855.5
Acceso en línea:	https://doaj.org/article/4de426adf5694d8fb846b0b7ff2a60d9
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spelling	oai:doaj.org-article:4de426adf5694d8fb846b0b7ff2a60d92021-12-02T00:13:24ZPeroral endoscopic myotomy: procedural complications and pain management for the perioperative clinician1179-1470https://doaj.org/article/4de426adf5694d8fb846b0b7ff2a60d92017-02-01T00:00:00Zhttps://www.dovepress.com/peroral-endoscopic-myotomy-procedural-complications-and-pain-managemen-peer-reviewed-article-MDERhttps://doaj.org/toc/1179-1470Lopa Misra,1 Norio Fukami,2 Katarina Nikolic,1 Terrence L Trentman1 1Department of Anesthesiology, 2Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Phoenix, AZ, USA Abstract: Achalasia refers to the lack of smooth muscle relaxation of the distal esophagus. Although nonsurgical treatments such as pneumatic dilatation of the distal esophagus and botulinum toxin injections have been performed, these procedures have limited duration. Similarly, surgical treatment with Heller myotomy is associated with complications. At our institution, we perform the peroral endoscopic myotomy (POEM) in qualified patients. Briefly, POEM involves endoscopic creation of a mid-esophageal submucosal bleb, creation of a submucosal tunnel with the endoscope, and then a distal myotomy, resulting in relaxation of the distal esophagus. The aim of our study is to document perioperative pain and associated pain management for our initial patients undergoing POEM and to review the literature for perioperative complications of this procedure. Therefore, anesthetic and pain management for our initial eleven patients undergoing POEM were reviewed. Patient demographics, pre-POEM pain medication history, perioperative pain medication requirements, and post-POEM pain scores were examined. We found post-POEM pain was usually in the mild–moderate range; a combination of medications was effective (opioids, nonsteroidal anti-inflammatory drugs, acetaminophen). Our literature search revealed a wide frequency range of complications such as pneumoperitoneum and subcutaneous emphysema, with rare serious events such as capnopericardium leading to cardiac arrest. In conclusion, our experience with POEM suggests pain and can be managed adequately with a combination of medications; the procedure appears to be safe and reasonable to perform in an outpatient endoscopy unit. Keywords: pain management, retrospective study, combination of medicines, perioperative, endoscopyMisra LFukami NNikolic KTrentman TLDove Medical Pressarticleachalasiaperoral endoscopic myotomyopioidsadverse eventspostoperative painMedical technologyR855-855.5ENMedical Devices: Evidence and Research, Vol Volume 10, Pp 53-59 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	achalasia peroral endoscopic myotomy opioids adverse events postoperative pain Medical technology R855-855.5
spellingShingle	achalasia peroral endoscopic myotomy opioids adverse events postoperative pain Medical technology R855-855.5 Misra L Fukami N Nikolic K Trentman TL Peroral endoscopic myotomy: procedural complications and pain management for the perioperative clinician
description	Lopa Misra,1 Norio Fukami,2 Katarina Nikolic,1 Terrence L Trentman1 1Department of Anesthesiology, 2Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Phoenix, AZ, USA Abstract: Achalasia refers to the lack of smooth muscle relaxation of the distal esophagus. Although nonsurgical treatments such as pneumatic dilatation of the distal esophagus and botulinum toxin injections have been performed, these procedures have limited duration. Similarly, surgical treatment with Heller myotomy is associated with complications. At our institution, we perform the peroral endoscopic myotomy (POEM) in qualified patients. Briefly, POEM involves endoscopic creation of a mid-esophageal submucosal bleb, creation of a submucosal tunnel with the endoscope, and then a distal myotomy, resulting in relaxation of the distal esophagus. The aim of our study is to document perioperative pain and associated pain management for our initial patients undergoing POEM and to review the literature for perioperative complications of this procedure. Therefore, anesthetic and pain management for our initial eleven patients undergoing POEM were reviewed. Patient demographics, pre-POEM pain medication history, perioperative pain medication requirements, and post-POEM pain scores were examined. We found post-POEM pain was usually in the mild–moderate range; a combination of medications was effective (opioids, nonsteroidal anti-inflammatory drugs, acetaminophen). Our literature search revealed a wide frequency range of complications such as pneumoperitoneum and subcutaneous emphysema, with rare serious events such as capnopericardium leading to cardiac arrest. In conclusion, our experience with POEM suggests pain and can be managed adequately with a combination of medications; the procedure appears to be safe and reasonable to perform in an outpatient endoscopy unit. Keywords: pain management, retrospective study, combination of medicines, perioperative, endoscopy
format	article
author	Misra L Fukami N Nikolic K Trentman TL
author_facet	Misra L Fukami N Nikolic K Trentman TL
author_sort	Misra L
title	Peroral endoscopic myotomy: procedural complications and pain management for the perioperative clinician
title_short	Peroral endoscopic myotomy: procedural complications and pain management for the perioperative clinician
title_full	Peroral endoscopic myotomy: procedural complications and pain management for the perioperative clinician
title_fullStr	Peroral endoscopic myotomy: procedural complications and pain management for the perioperative clinician
title_full_unstemmed	Peroral endoscopic myotomy: procedural complications and pain management for the perioperative clinician
title_sort	peroral endoscopic myotomy: procedural complications and pain management for the perioperative clinician
publisher	Dove Medical Press
publishDate	2017
url	https://doaj.org/article/4de426adf5694d8fb846b0b7ff2a60d9
work_keys_str_mv	AT misral peroralendoscopicmyotomyproceduralcomplicationsandpainmanagementfortheperioperativeclinician AT fukamin peroralendoscopicmyotomyproceduralcomplicationsandpainmanagementfortheperioperativeclinician AT nikolick peroralendoscopicmyotomyproceduralcomplicationsandpainmanagementfortheperioperativeclinician AT trentmantl peroralendoscopicmyotomyproceduralcomplicationsandpainmanagementfortheperioperativeclinician
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Peroral endoscopic myotomy: procedural complications and pain management for the perioperative clinician

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