An Enhanced Recovery After Surgery (ERAS) Protocol for Ambulatory Anorectal Surgery Reduced Postoperative Pain and Unplanned Returns to Care After Discharge

Parrish, Aaron B.; O’Neill, Sean M.; Crain, Steven R.; Russell, Tara A.; Sonthalia, Deepak K.; Nguyen, Vu T.; Aboulian, Armen

doi:10.1007/s00268-017-4414-8

Cited by 43 publications

(34 citation statements)

References 45 publications

(56 reference statements)

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“…However, these studies vary widely in their methodology and targeted patient populations. Some studies were limited by the generalization of implementing their recommendations in other medical institutions [25][26][27][28]. Recently we have implemented a novel multidisciplinary, evidencebased, neurosurgical ERAS program for elective craniotomy patients in a single center [1].…”

Section: Discussionmentioning

confidence: 99%

“…Development of standardized pain management and ERAS protocols may help optimize patient-reported outcomes and reduce health care costs 1 , 23 . The majority of reported ERAS programs for pain management dependent multidisciplinary cooperation, which include the efforts of neurosurgeons, anesthetists, residents, operating room nurses, neurophysiologist, dieticians and the support from family members of the patient 1 , 24 - 26 . However, these studies vary widely in their methodology and targeted patient populations.…”

Section: Discussionmentioning

confidence: 99%

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Management of Postoperative Pain after Elective Craniotomy: A Prospective Randomized Controlled Trial of a Neurosurgical Enhanced Recovery after Surgery (ERAS) Program

Qu¹,

Liu

Zhang³

et al. 2020

Int. J. Med. Sci.

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Objective: To prospectively evaluate the efficacy of a neurosurgical enhanced recovery after surgery (ERAS) protocol on the management of postoperative pain after elective craniotomies. Methods: This randomized controlled trial was conducted in the neurosurgical center of Tangdu Hospital (Fourth Military Medical University, Xi'an, China). A total of 129 patients undergoing craniotomies between October 2016 and July 2017 were enrolled in a randomized clinical trial comparing an ERAS protocol to a conventional postoperative care regimen. The primary outcome was the postoperative pain score assessed by a verbal numerical rating scale (NRS). Results: Patients in the ERAS group had a significant reduction in their postoperative pain scores on POD 1 compared to patients in the control group (p < 0.05). More patients (n = 44, 68.8%) in the ERAS group experienced mild pain (NRS: 1 to 3) on POD1 compared with patients (n = 23, 35.4%) in the control group (p < 0.05). A further reduction in pain scores was also observed on POD 2 and maintained on POD 3 in the ERAS group compared with that in the control group. In addition, the median postoperative length of hospital stay was significantly decreased with the incorporation of the ERAS protocol compared to controls (ERAS: 4 days, control: 7 days, P<0.001). Conclusion: The implementation of a neurosurgical ERAS protocol for elective craniotomy patients has significant benefits in alleviating postoperative pain and enhancing recovery leading to early discharge after surgery compared to conventional care. Further evaluation of this protocol in larger, multi-center studies is warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Management of Postoperative Pain after Elective Craniotomy: A Prospective Randomized Controlled Trial of a Neurosurgical Enhanced Recovery after Surgery (ERAS) Program

Qu¹,

Liu

Zhang³

et al. 2020

Int. J. Med. Sci.

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“…Recently, it has become a routine practice to adequately inform patients about even the simplest applications of surgical procedures. Another important aspect of preoperative information programs is providing early information regarding problems, such as pain and complications, that patients may encounter; such programs make the application of the ERAS protocol more effective (29,30). In our own practice, after multidisciplinary teams evaluated the patients, the surgical oncologists provided the patients with all the relevant information regarding their current situation, disease, disease stage, interventions, and treatment strategies that can be applied.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Enhanced Recovery After Following a Surgical Protocol for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis

Düzgün

2019

Med Arch

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Introduction: Cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy (CRS ± HIPEC) has positive effects on the survival of patients with peritoneal carcinomatosis (PC) due to intra-abdominal tumors. Currently, the available literature on the safety of the Enhanced Recovery After Surgery (ERAS) protocol for PC, which is associated with severe morbidity and mortality, is insufficient. Aim: This study aimed to present our results from treating patients using the ERAS protocol for PC that developed due to intra-abdominal tumors. Material and Methods: The data of 120 consecutive patients with PC due to different etiologies of abdominal origin and who underwent CRS ± HIPEC were analyzed. The patients were divided into two groups according to whether the ERAS protocol was applied. Information on demographics, length of hospital stay, cost, morbidity, and mortality was statistically compared between groups. Results: A total of 102 patients were included in the study. The first 40 patients did not undergo the ERAS protocol, whereas 62 patients did undergo the protocol. The mean length of hospital stay was 10 days in the non-ERAS group and 7 days in the ERAS group. The ERAS group was observed to have earlier mobilization, earlier gas and stool release, lower oral intake, and fewer respiratory problems than the non-ERAS group. Conclusion: CRS ± HIPEC has a positive effect on survival. The simultaneous application of the ERAS protocol with the aforementioned procedure has positive effects on intestinal motility and postoperative outcomes. In addition, this protocol may reduce costs by shortening the length of hospital stay.

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“…1,2 Current guidelines for colorectal and anorectal surgery recommend discharging patients only after achievement of a subjectively low level of pain, 3 but pain is among the primary reasons for readmission after anorectal surgery. 4 Recently published Enhanced Recovery After Surgery (ERAS) protocols for short-stay anorectal and colorectal surgery recommend the implementation of differentiated pain management to reduce both postoperative pain and readmissions, 5,6 but patients' sensitivity to pain is highly variable 7,8 and influenced by complex factors such as sex 8 and anxiety. 9 While the pressure pain threshold (PPT) method has been studied in various settings, it became a standard for quantitative sensory tests.…”

Section: Anesthesia and Analgesiamentioning

confidence: 99%

Preoperative Pressure Pain Threshold Is Associated With Postoperative Pain in Short-Stay Anorectal Surgery: A Prospective Observational Study

Luedi

Schober

Hammoud³

et al. 2020

Anesthesia &Amp; Analgesia

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Is preoperative pressure pain threshold associated with postoperative pain in anorectal surgery? • Findings: Preoperative pressure pain threshold is associated with postoperative pain in anorectal surgery and can help identify patients at risk for developing more severe postoperative pain. • Meaning: Preoperative pressure pain can anticipate postoperative pain in anorectal surgery, thereby facilitating planning for surgery and avoiding readmission due to pain. BACKGROUND: Postoperative pain management is key for patient satisfaction. Pressure pain threshold (PPT) has been studied in some surgical cohorts but has not been studied in relationship to acute postoperative pain in short-stay patients undergoing anorectal surgery. We hypothesized that preoperative finger PPT measurements can identify respective patients with higher postoperative pain. Aiming to understand the relationship with subjective postoperative pain perception, we tested the hypotheses that preoperative PPT is associated with postoperative Visual Analog Scale (VAS) pain scores and correlates with postoperative analgesic consumption in short-stay patients undergoing anorectal surgery. METHODS: We prospectively assessed preoperative PPT in a cohort undergoing anorectal surgery, known as a moderately to severely painful procedure. Linear mixed-effects models were used to assess the relationship with postoperative VAS pain scores at 1 and 3 days as well as 4 weeks postoperatively. Logistic regression was used to study the relationship with additional postoperative analgesic consumption. RESULTS: We studied 128 patients and found that preoperative PPT is significantly associated with postoperative pain (P value for interaction = .025). Logistic regression modeling additionally revealed an association between the preoperative PPT and the need for additional postoperative analgesics, with odds of requiring additional analgesia decreasing by about 10% for each 1-point increase in PPT (odds ratio [OR] = 0.90; 95% confidence interval [CI], 00.81-0.98; P = .012). CONCLUSIONS: Preoperative finger PPT is associated with postoperative pain and might help identify patients who are at risk of developing more severe postoperative pain on anorectal surgery. Especially in ambulatory and short-stay settings, this approach can help to address patients' high variability in pain sensitivity to facilitate appropriate postoperative analgesia, timely discharge, and prevent readmission.

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An Enhanced Recovery After Surgery (ERAS) Protocol for Ambulatory Anorectal Surgery Reduced Postoperative Pain and Unplanned Returns to Care After Discharge

Abstract: Implementation of a standardized ERAS protocol for ambulatory anorectal surgery decreased postoperative pain and unplanned return visits to emergency care.

Cited by 43 publications

References 45 publications

Management of Postoperative Pain after Elective Craniotomy: A Prospective Randomized Controlled Trial of a Neurosurgical Enhanced Recovery after Surgery (ERAS) Program

Management of Postoperative Pain after Elective Craniotomy: A Prospective Randomized Controlled Trial of a Neurosurgical Enhanced Recovery after Surgery (ERAS) Program

Evaluation of Enhanced Recovery After Following a Surgical Protocol for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis

Preoperative Pressure Pain Threshold Is Associated With Postoperative Pain in Short-Stay Anorectal Surgery: A Prospective Observational Study

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