Evaluation of open reduction of distal humerus fractures in children after implementation of an enhanced recovery after surgery program

Abstract

Objective This study assessed whether an enhanced recovery after surgery (ERAS) protocol could be beneficial for children with distal humerus fractures. Methods Children with distal humerus fractures (n = 85) were randomly assigned to the ERAS and control groups and subjected to different perioperative managements. This was followed by the evaluation of their intraoperative characteristics (operation time and bleeding), postoperative characteristics (food intake conditions, pain scores, and discharge time), and postoperative functions. Results The operation time, intraoperative bleeding, and postoperative hematological indices did not differ significantly between the two groups. Preoperative thirst and hunger were considerably less and the initial food intake duration following surgery was markedly shorter in the ERAS group than in the control group, whereas no difference between the groups was observed in the incidences of postoperative nausea and vomiting. A markedly reduced highest postoperative pain score and reduced mean pain score and demand for additional analgesic interventions were observed in the ERAS group compared with those in the control group, although the differences were not statistically significant. No noticeable between-group differences were observed in the incidences of postoperative incision problems, aspirational pneumonia, and gastroesophageal reflux. The total length of hospital stay was not significantly different between the two groups. However, the length of postoperative hospital stay was remarkably shorter and the elbow joint function at 2 months after surgery was significantly improved in the ERAS group compared with those in the control group. Conclusion The ERAS protocol can ameliorate preoperative discomfort and postoperative pain, shorten the postoperative hospital stay, and accelerate postoperative functional recovery without increasing the risks of postoperative nausea, vomiting, and poor incision healing and is, therefore, worthy of clinical application.

Clinical application of enhanced recovery after surgery concept in laparoscopic treatment of pediatric acute appendicitis

“…Surgeons, such as Henrik Kehlet [ 3 ], originally proposed the core concept of ERAS, which integrated multiple high-quality clinical evidence-based medical evidence into perioperative management to improve the perioperative trauma and stress response and accelerate recovery. A 2022 clinical study that applied the ERAS concept to 85 children undergoing surgery showed that the ERAS regimen could accelerate postoperative functional recovery without increasing the risk of postoperative nausea, vomiting, and poor incision healing; However, they mainly discussed pediatric orthopedics [ 4 ]. A team from the Hannover Medical School in Germany surveyed the length of stay, patient satisfaction, parent satisfaction, pain management, complications, etc.…”