Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS®) Society recommendations

Debono, Bertrand; Wainwright, Tom; Wang, Michael Y.; Sigmundsson, F.; Yang, Michael; Smid‐Nanninga, Henriette; Bonnal, A.; Huec, Jean-Charles Le; Fawcett, William; Ljungqvist, Olle; Lonjon, Guillaume; Boer, H. de

doi:10.1016/j.spinee.2021.01.001

Cited by 177 publications

(131 citation statements)

References 272 publications

(200 reference statements)

Supporting

Mentioning

126

Contrasting

Unclassified

Order By: Relevance

“…51,52 Patients undergoing these surgeries often experience significant postoperative pain, long recovery times, and high rates of complications. 53,54 ERAS is thus a potential solution to reduce LOS, improve patient outcomes, and reduce postoperative opioid use.…”

Section: Interventions To Reduce Usage and Their Outcomes Enhanced Recovery After Surgery Protocolmentioning

confidence: 99%

“…Regarding lumbar surgery specifically, the ERAS society, a group designed to provide expert consensus on ERAS protocol recommendations for specific surgical subspecialties, recently investigated available data and made numerous recommendations. 54 In the preoperative period, recommendations are focused on preoperative counseling and education, nutrition assessment, cessation of smoking and alcohol, preoperative fasting to include clear fluids up to 2 hours and solid foods up to 6 hours before surgery, and management of preoperative anemia. 55 Further, the use of sedatives for anxiolysis preoperatively is not recommended.…”

Section: Interventions To Reduce Usage and Their Outcomes Enhanced Recovery After Surgery Protocolmentioning

confidence: 99%

“…In contrast to this, NSAIDs, neuropathic pain medicines, and acetaminophen have been shown in numerous random-An Update on Postoperative Opioid Use and Alternative Pain Control Following Spine Surgery Orthopedic Reviews ized control trials and meta-analyses to reduce opioid use. 54,56,57 Intraoperatively, the ERAS protocol focuses on antimicrobial skin preparation, intraoperative anesthetics with neuromuscular blockade, and neuraxial techniques such as epidural anesthetics and inhalational agents, the prevention of hypothermia, the use of local and regional anesthetics, and careful fluid and urinary volume management. 54 Specifically, randomized control trials have shown that intrathecal morphine and epidural anesthetics such as bupivacaine directly reduce opioid use after spine surgery.…”

Section: Interventions To Reduce Usage and Their Outcomes Enhanced Recovery After Surgery Protocolmentioning

confidence: 99%

“…54,56,57 Intraoperatively, the ERAS protocol focuses on antimicrobial skin preparation, intraoperative anesthetics with neuromuscular blockade, and neuraxial techniques such as epidural anesthetics and inhalational agents, the prevention of hypothermia, the use of local and regional anesthetics, and careful fluid and urinary volume management. 54 Specifically, randomized control trials have shown that intrathecal morphine and epidural anesthetics such as bupivacaine directly reduce opioid use after spine surgery. [58][59][60] Direct wound installations with local anesthetics such as ropivacaine and bupivacaine have also been demonstrated to decrease opioid use.…”

Section: Interventions To Reduce Usage and Their Outcomes Enhanced Recovery After Surgery Protocolmentioning

confidence: 99%

“…61 Postoperatively, particular attention is given to nausea control, early mobilization, and postoperative management of drains. 54 In addition, a multimodal approach is taken to postoperative prescription medication management. Among this approach, acetaminophen, NSAIDs, and neuropathic pain medications, including gabapentinoids, remain the cornerstone of treatment.…”

Section: Interventions To Reduce Usage and Their Outcomes Enhanced Recovery After Surgery Protocolmentioning

confidence: 99%

See 4 more Smart Citations

An Update on Postoperative Opioid Use and Alternative Pain Control Following Spine Surgery

et al. 2021

View full text Add to dashboard Cite

Opioids are commonly prescribed postoperatively for pain control, especially in spine surgery. Not only does this pose concerns for potential abuse, but it also has been shown to worsen certain outcomes. Risk factors for increased use include preoperative opioid use, female sex, psychiatric diagnoses, and drug and alcohol use. Over the past few decades, there have been increasing efforts mostly spearheaded by governmental agencies to decrease postoperative opioid use via opioid prescription limitation laws regulating the number of days and amounts of analgesics prescribed and promotion of the use of enhanced recovery after surgery (ERAS) protocols, multimodal pain regimens, epidural catheters, and ultrasound-guided peripheral nerve blocks. These strategies collectively have been efficacious in decreasing overall opioid use and better controlling patients' postoperative pain while simultaneously improving other outcomes such as postoperative nausea, vomiting, and length of stay. With an aging population undergoing an increasing number of spinal surgeries each year, it is now more important than ever to continue these efforts to improve the quality and safety of pain control methods after spinal surgery and limit the transition of acute management to the development of opioid dependence and addiction long-term.

show abstract

Section: Interventions To Reduce Usage and Their Outcomes Enhanced Recovery After Surgery Protocolmentioning

confidence: 99%

Section: Interventions To Reduce Usage and Their Outcomes Enhanced Recovery After Surgery Protocolmentioning

confidence: 99%

Section: Interventions To Reduce Usage and Their Outcomes Enhanced Recovery After Surgery Protocolmentioning

confidence: 99%

Section: Interventions To Reduce Usage and Their Outcomes Enhanced Recovery After Surgery Protocolmentioning

confidence: 99%

Section: Interventions To Reduce Usage and Their Outcomes Enhanced Recovery After Surgery Protocolmentioning

confidence: 99%

See 3 more Smart Citations

An Update on Postoperative Opioid Use and Alternative Pain Control Following Spine Surgery

et al. 2021

View full text Add to dashboard Cite

show abstract

Opportunities and Challenges for the Next Phase of Enhanced Recovery After Surgery

et al. 2021

View full text Add to dashboard Cite

ERAS) is a global surgical quality improvement initiative now firmly entrenched within the field of perioperative care. Although ERAS is associated with significant clinical outcome improvements and cost savings in numerous surgical specialties, several opportunities and challenges deserve further discussion.OBSERVATIONS Uptake and implementation of ERAS Society guidelines, together with ERAS-related research, have increased exponentially since the inception of the ERAS movement. Opportunities to further improve patient outcomes include addressing frailty, optimizing nutrition, prehabilitation, correcting preoperative anemia, and improving uptake of ERAS worldwide, including in low-and middle-income countries. Challenges facing enhanced recovery today include implementation, carbohydrate loading, reversal of neuromuscular blockade, and bowel preparation. The COVID-19 pandemic poses both a challenge and an opportunity for ERAS. CONCLUSIONS AND RELEVANCETo date, ERAS has achieved significant benefit for patients and health systems; however, improvements are still needed, particularly in the areas of patient optimization and systematic implementation. During this time of global crisis, the ERAS method of delivering care is required to take surgery and anesthesia to the next level and bring improvements in outcomes to both patients and health systems.

show abstract

Robotic‐Assisted Lumbar Fusion: An Effective Technique for Pedicle Screw Placement

Karasin¹,

Rizzo²,

Hardinge³

et al. 2022

AORN Journal

View full text Add to dashboard Cite

Degenerative lumbar disease is a common condition in which progressive deterioration of the structures in the spine causes severely incapacitating pain and disability. Conservative management, including passive or active physical therapy, activity modification, and medications (eg, anti‐inflammatory medications, oral and injectable steroids, opioids), may provide relief. However, when conservative management is unsuccessful or patients experience symptoms for an extended period of time, they may require spine surgery. Surgeons use a variety of techniques to perform lumbar fusion procedures with instrumentation, including open, percutaneous, minimally invasive, and robotic‐assisted with navigation. The accuracy of pedicle‐screw placement varies according to the technique used, and accuracy rates are high after robotic‐assisted with navigation procedures. In addition, robotic‐assisted spine procedures result in fewer infections than non–robotic‐assisted spine procedures (P = .04). Perioperative nurses should understand basic lumbar spine anatomy, steps completed during robotic‐assisted lumbar spine surgery, and the nursing considerations for patients undergoing this type of procedure.

show abstract

Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS®) Society recommendations

Cited by 177 publications

References 272 publications

An Update on Postoperative Opioid Use and Alternative Pain Control Following Spine Surgery

An Update on Postoperative Opioid Use and Alternative Pain Control Following Spine Surgery

Opportunities and Challenges for the Next Phase of Enhanced Recovery After Surgery

Robotic‐Assisted Lumbar Fusion: An Effective Technique for Pedicle Screw Placement

Contact Info

Product

Resources

About