Enhanced

Enhanced Recovery After Surgery (ERAS)

Enhanced Recovery After Surgery (ERAS) protocols aim to improve patient outcomes.

Enhanced Recovery After Surgery (ERAS) is a multimodal perioperative care pathway designed to achieve early recovery for patients undergoing major surgery. The ERAS protocol is based on evidence-based practices that aim to reduce the surgical stress response, maintain postoperative physiological function, and accelerate recovery.

History

The concept of ERAS was first introduced in the late 1990s by Professor Henrik Kehlet, a Danish surgeon, who recognized the need for a comprehensive approach to perioperative care. The ERAS Society was later established to promote research and education in this field.

Key Components

ERAS protocols encompass several key components that span the entire surgical journey, from preoperative to postoperative care. These components include:

Preoperative Care

• Patient Education: Informing patients about the surgical procedure, expected outcomes, and recovery process.
• Nutritional Optimization: Ensuring patients are nutritionally prepared for surgery, often including carbohydrate loading.
• Prehabilitation: Encouraging physical activity and exercises to improve fitness before surgery.

Intraoperative Care

• Minimally Invasive Techniques: Utilizing laparoscopic or robotic surgery to reduce tissue trauma.
• Anesthetic Management: Employing regional anesthesia and multimodal analgesia to minimize opioid use.
• Fluid Management: Maintaining euvolemia to prevent fluid overload or deficit.

Postoperative Care

• Early Mobilization: Encouraging patients to ambulate soon after surgery to prevent complications such as deep vein thrombosis.
• Early Oral Nutrition: Promoting early intake of oral fluids and food to enhance gut function.
• Pain Management: Using non-opioid analgesics and regional techniques to control pain.

Benefits

ERAS protocols have been shown to reduce hospital length of stay, decrease postoperative complications, and improve patient satisfaction. By focusing on a holistic approach to surgical care, ERAS aims to enhance recovery and reduce healthcare costs.

Challenges

Implementing ERAS protocols can be challenging due to the need for multidisciplinary collaboration and adherence to guidelines. Variability in practice and resistance to change can also hinder the adoption of ERAS.

Future Directions

Research continues to refine and expand ERAS protocols, with a focus on personalized medicine and the integration of new technologies. The future of ERAS may involve tailoring protocols to individual patient needs and incorporating digital health tools.

Related Pages

• Surgery
• Anesthesia
• Postoperative care
• Minimally invasive surgery