Opioid-Sparring and Multimodal Analgesia as Parts of Enhanced Recovery After Surgery (ERAS) Applied In The Ksatria Airlangga Floating Hospital

Abstract

Introduction: Enhanced Recovery After Surgery (ERAS) protocol is a perioperative multimodal service program designed to achieve a faster surgical recovery period and a better outcome, the key in reducing morbidity in surgery is by reducing the “surgical injury” and reducing the body’s stress response caused by the surgery. The success of the ERAS protocol depends on the interpretation and collaboration of the multidisciplinary team, therefore though the protocol is carried out in a hospital that has sufficient facilities and resources, the obstacle in the implementation of ERAS can still happen. The implementation of ERAS protocol in the non-permanent hospital service facility becomes a challenge in itself. Case Reports: From the two case reports of the implementation of ERAS protocol in the Ksatria Airlangga Floating Hospital (RST-KA) it is obtained that the key success of the anesthesia in ERAS protocol above lies on the administration of opioid-sparring therapy where it will reduce the use of opioid. Although there are many obstacles obtained in the RST-KA, the use of ERAS protocol can be conducted by making effective use of opioid-sparring combined with the administration of multimodal analgesia. Conclusion: Therefore, it can be concluded that the ERAS protocol can be applied in the social service concept in the non-permanent health facility.

Preliminary Survey in preparation for the implementation of ERAS at Dr Soetomo Hospital

“…ERAS has been proven to be well implemented in social-based health services such as the Airlangga Ksatria Floating Hospital. 10 When properly prepared, ERAS is not only able to shorten the length of stay in the hospital but also minimize the incidence of postoperative complications. 3,13 several other studies have found that adherence to the ERAS protocol is associated with lower postoperative complications in liver cancer patients undergoing liver resection surgery.…”

Comparative analysis of lumbar quadratus lumborum block and epidural block for analgesia in uterine surgery at Dr. Soetomo Hospital, Surabaya

“…Local anesthetics also act on autonomic nerves, causing vasodilation of peripheral blood vessels through sympathetic blockage in the posterior hypothalamus [ 18 ]. When combined with enhanced recovery after surgery protocols, regional anesthesia can decrease the need for opioids, thereby reducing opioid-related side effects such as sedation, nausea, vomiting, urinary retention, respiratory depression, bowel dysfunction, ileus, and sleep disturbances [ 19 ].…”