Enhanced recovery after surgery is a term used to describe new ideas and protocols in the care of surgical patients. These ideas involve standardization of care and dramatic changes in those standards starting with the scheduling of surgery through discharge from the hospital and beyond.
Dr. Henrik Kehlet, a surgeon from Denmark, is credited with the earliest ERAS protocols in the 1990s. He challenged established standards with new ideas and was ridiculed early on, as many pioneers are. Gradually, his ideas were accepted and are now considered standard of care throughout much of Europe, and they are expanding rapidly in the United States, including Kentucky and specifically Fayette County.
Although Kehlet is a surgeon, the American Society of Anesthesiology presented him with an award in 2014 for his impact of the practice of anesthesiology as a medical specialty.
The first ERAS program in the United States was in 2010 at Duke University. ERAS protocols usually include patient education and motivation, early feeding and mobilization, standardized fluid therapy and multimodal analgesia (combining various meds and approaches).
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Regional anesthesia (blocks) is a particularly beneficial aspect of this multimodal approach. Tylenol, non-steroidal anti-inflammatory drugs, gabapentin and many other drugs are used as parts of this approach to pain treatment. Narcotic use by patients in these protocols may drop as much as 90 percent compared with non-ERAS patients while achieving superior pain relief and reductions in nausea.
Goals including decreased length of stay, fewer complications, reduced cost, less pain, less nausea and improved patient satisfaction have been achieved using ERAS protocols. Some institutions have documented cutting length of stay by 50 percent for colon resections while at the same time reducing complications.
Surgeons, anesthesia providers, nurses, allied health professionals and administrators are required to function as a team to make this work. Seeing this happen and succeed has been one of the most rewarding and significant events in my 30-year career. I have always said that surgery is a team sport. With ERAS the team is much larger and functions more effectively for the patient.
The American Society of Enhanced Recovery was formed in 2014 and now has a journal, regular meetings, and a website for those wanting to keep up with the latest concepts in improving surgical care.
Dr. Thomas L. Broster, an anesthesiologist with Central Kentucky Anesthesia, practices at Baptist Health Lexington.