Benefits of Enhanced Recovery After Surgery in Patients Undergoing Endoscopic Sinus Surgery

Abstract

Background Although enhanced recovery after surgery (ERAS) protocols have been widely applied during perioperative periods for different diseases, there are few reports of ERAS in patients undergoing endoscopic sinus surgery (ESS). This study therefore aimed to evaluate the benefits of ERAS protocol compared to traditional care following ESS. Methods A total of 55 patients with chronic rhinosinusitis undergoing ESS were prospectively assigned to 1 of 5 treatment groups; ERAS groups with postoperative intravenous Flubiprofen Axetil or analgesia pump, traditional care with Flubiprofen Axetil or analgesia pump (NERAS groups), or traditional care without postoperative intravenous analgesia group (control). All patients completed the Kolcaba General Comfort Questionnaire, Medical Outcomes Study Sleep Scale, and Self-rating Anxiety Scale at admission and before discharge. Pain scores were recorded at 2, 6, 24, and 48 hours postsurgery and adverse reactions to analgesics were noted. Results Patients in ERAS group demonstrated significantly higher general comfort scores and lower self-rating anxiety scores compared to patients in NERAS and control groups. Compared to control patients, patients in ERAS group reported significantly lower pain scores at 6, 24, and 48 hours. Moreover, pain alleviated from 6 hours postsurgery in ERAS group compared to 48 hours in NERAS group. Patients using opioids experienced more adverse nausea events than patients using only nonsteroidal anti-inflammatory drugs (NSAIDs). Conclusions The use of patient-tailored ERAS programs following ESS may help to attain higher general comfort and to alleviate perioperative anxiety compared with traditional perioperative care. Adequate postoperative analgesia with NSAIDs in ERAS protocol may alleviate pain earlier with fewer adverse reactions.

Enhanced recovery after surgery protocols for outpatient operations in otolaryngology: Review of literature

“…After excluding duplicates, 44 full‐text articles were assessed in their entirety for inclusions. Finally, eight articles were deemed appropriate for inclusion for this study 20–27 . The flowchart in Figure 1 provides a summary of the article selection process.…”

“…Finally, eight articles were deemed appropriate for inclusion for this study. [20][21][22][23][24][25][26][27] The flowchart in Figure 1 provides a summary of the article selection process.…”

The application of enhanced recovery after surgery (ERAS) in chronic rhinosinusitis patients undergoing endoscopic sinus surgery: A systematic review and meta-analysis

“…We found that CRS patients from the ERAS group scored distinctly lower pain than patients from the SC group. Besides that, Gao et al’s [ 54 ] prospective cohort study surveyed pain in CRS patients undergoing ESS and found a dramatic improvement in pain after 6 hours postoperatively in patients of ERAS group. Multimodal analgesia in ERAS strategies provides optimal pain relief for CRS patients, reducing the use of opioids and their harm to body organs, allowing early-stage feeding and early mobilization for patients after surgery as well as enabling a higher QOL [ 16 , 55 ].…”

“…To avoid these mentioned problems, it is imperative to focus on the mental health of CRS patients in the perioperative period. The cohort study by Gao et al [ 54 ] suggested that ERAS program could improve the emotions of CRS patients who receive ESS. In this meta-analysis, anxiety and depression scores as well as pain scores were markedly lower in ERAS versus SC group.…”