Enhanced Recovery After Surgery: History, Evolution, Guidelines, and Future Directions

Tanious, Mariah K.; Ljungqvist, Olle; Urman, Richard D.

doi:10.1097/aia.0000000000000167

Cited by 25 publications

(16 citation statements)

References 33 publications

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“…This concept -referred to as the 'knowingdoing gap' continues to be a major obstacle in delivering ERAS [22]. These include patients, healthcare professional and institutional barriers, with many reasons such as ERAS programmes not meeting patient expectations and perspectives, issues related to medical and nursing staff (resistance to change, staff turnover and workload, inadequate training and support) and institutional reasons such as poor leadership, inadequate funding and importantly the lack of good data collection which will in turn not allow reliable auditing and implementation of continuous feedback [23].…”

Section: How Many Elements On the Pathway?mentioning

confidence: 99%

Enhanced recovery: joining the dots

Fawcett

Mythen

Scott

2021

British Journal of Anaesthesia

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Section: How Many Elements On the Pathway?mentioning

confidence: 99%

Enhanced recovery: joining the dots

Fawcett

Mythen

Scott

2021

British Journal of Anaesthesia

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“…Innovation of technology provides opportunities to overcome challenges with ERAS [100][101][102]. Databases facilitate core data collection, ensure optimal adherence to protocols, and reduce variability in clinical care.…”

Section: Future Directionsmentioning

confidence: 99%

Optimizing Outcomes with Enhanced Recovery

Thacker

Morin

2021

The ASCRS Textbook of Colon and Rectal Surgery

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Concepts• Enhanced recovery is the process of defining modifiable sources of perioperative stress to the surgical patient and applying standardized evidence-based interventions through all phases of care to avoid complications, facilitate faster recovery and discharge (without increasing readmission rates), and reduce hospital costs. • Champions from surgery, anesthesia, and nursing are essential to the ERAS team, while other members for protocol creation include pharmacy, IT, nutrition, and administration. • Key elements of patient care delivery can be broken down into five phases, each assigned to and delivered by a different team while certain elements present across phases: preoperative, perioperative, intraoperative, postoperative, and post-discharge. • Implementation of the Enhanced Recovery Program, ERP, requires order sets, team education, and administrative help as well as databases to facilitate data collection and ensure optimal compliance and quality control. • ERAS principles are widely applicable and have been proven safe and beneficial in emergency and IBD patients, those with diverting ostomies, and elderly patients, realizing that readiness for discharge rather than length of stay is a more accurate outcome measure. • Moving forward, technology will assist in gathering patient recovery-centric outcome measures in addition to the traditional audit measures to further quality improvement efforts.Intrinsic to the personality of a surgeon is the drive toward perfect outcomes. Benchmarking, quality improvement comparisons, and inherent competitiveness all allow surgeons the means to evaluate their performance. Enhanced recovery principles, by contrast, focus on intervention elements. Specifically, enhanced recovery focuses on the surgical stress imposed on unique patient populations. This chapter focuses on enhanced recovery efforts, details, challenges, and future directions in the elective colorectal surgery patient.

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“…ERAS protocols are multi-modal, evidence-based methods aimed at improving patient outcomes and satisfaction after surgery. 1 The goals of ERAS include decreasing patient stress response, length of hospital stay, surgical complications and recovery time back to baseline function. 1 Moreover, with growing concern regarding the epidemic of opioid use, abuse and misuse and associated morbidity and mortality, finding opioid-sparing methods for arthroscopic surgeries have become of increasing importance.…”

Section: Introductionmentioning

confidence: 99%

Superior Block Length and Reduced Opioid Use with Dexmedetomidine and Dexamethasone regional block versus plain Ropivacaine: a retrospective trial

et al. 2022

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Purpose The purpose of this study is to determine if using a combination of dexamethasone and dexmedetomidine (Dex-Dex) in a single-shot perineural local anesthestic provides an increased duration of pain relief and reduced consumption of opioids for patients undergoing shoulder surgery. Patients and methods This is a retrospective trial of adult patients without major comorbidities undergoing elective, upper arm orthopedic procedures with regional nerve block for post-operative analgesia. Patients underwent nerve block with either 0.5% ropivacaine or 0.2% ropivacaine with 5mg dexamethasone and 25mg dexmedetomidine (“dex-dex”). Patients were assessed in 1-week intervals for two weeks for duration of block analgesia, pain scores, and opioid use. Results 31 patients were included, 12 controls and 19 in the dex-dex group. These patients underwent one of arthroscopic rotator cuff repair, reverse total shoulder repair or repair of humerus fractures. Dex-dex blocks provided significantly longer analgesia (median block time 3.5 versus 1.5 days, p<0.0001), significantly better analgesia (mean NRS 2.32 versus 8.58 on post-operative day 1, p<0.0001), and significantly reduced opioid requirements (108.16mg vs 275.63mg in MME, p<0.0001). One patient experienced transient hypotension and prolonged paresthesia in the dex-dex group. Conclusion Preoperative single-shot interscalene nerve blocks with preservative-free dexamethasone and dexmedetomidine added as adjuvants to ropivicaine provide approximately two additional days of benefit versus ropivicaine alone. Additionally, postoperative opioid consumption is reduced.

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Enhanced Recovery After Surgery: History, Evolution, Guidelines, and Future Directions

Cited by 25 publications

References 33 publications

Enhanced recovery: joining the dots

Enhanced recovery: joining the dots

Optimizing Outcomes with Enhanced Recovery

Superior Block Length and Reduced Opioid Use with Dexmedetomidine and Dexamethasone regional block versus plain Ropivacaine: a retrospective trial

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