Abstract
Objective: To prospectively evaluate the efficacy of improvement on postoperative pain after elective craniotomies based on neurosurgical enhanced recovery after surgery (ERAS) protocol. Methods: This randomised controlled trial was conducted in neurosurgical center of Tangdu Hospital (Fourth Military Medical University, Xi’an, China). A total of 129 patients undergoing craniotomies between October 2016 and July 2017 were enrolled in a randomized clinical trial comparing ERAS protocol and conventional care. The primary outcome was the score of postoperative pain by means of a verbal numerical rating scale (NRS). Results: Patients following ERAS had a significant reduction in postoperative pain according to the NRS score on POD 1 compared to patients with control group (mean NRS 3.12 vs. 4.44, OR 0.0968, 95% CI 0.3299 to 2.317, p = 0.010). More patients (n = 44, 68.8%) in ERAS groups experienced mild pain (NRS: 1 to 3) on POD1, which compared with patients (n = 23, 35.4%) in control groups (p < 0.05). The difference reached a reduction from POD 2 to POD 3 in ERAS group postoperatively compared with that in control group (POD2: mean NRS 2.85 vs. 4.32, OR 0.2628, 95% CI 0.5619 to 2.379, p=0.002. POD3: mean NRS 2.32 vs. 4.03, OR 0.1468, 95% CI 0.9537 to 2.458, p < 0.001, respectively). In addition, the median postoperative length of hospital stay was significantly decreased with the incorporation of ERAS protocol compared to conventional standard care (ERAS: 4 days, control: 7 days, respectively, P<0.001]. Conclusion: Implementation of the neurosurgical ERAS protocol for elective craniotomies have significant benefits on alleviating postoperative pain and enhancing recovery after surgery compared to the conventional care. Further evaluation of this protocol in larger, multi-center studies is warranted. Trial Registration Number: ChiCTR-INR-16009662. Funding Statement: This work was supported by China Natural Science Foundation (81572470 and 81601100). Declaration of Interests: The authors state: None declared. Ethics Approval Statement: The study was approved by the Ethical Committee of Tangdu Hospital at the Fourth Military Medical University. Informed consent was achieved from all individual participants or their legal representatives included in this study.
Highlights
With the increasing public expectations for high quality and efficient healthcare, there is a trend that more clinicians, especially neurosurgeons, are making efforts to optimize patient outcomes by addressing pre, peri, and post-operative factors[1,2]
Implementation of the neurosurgical Enhanced recovery after surgery (ERAS) protocol for elective craniotomy patients have significant benefits in alleviating postoperative pain and enhancing recovery after surgery compared to the conventional care
By implementing an evidence-based neurosurgical ERAS protocol among 129 patients undergoing craniotomies at the Neurosurgical center of Tangdu Hospital, Fourth Military Medical University (Xi’an, China) we evaluated the efficacy of improvement on postoperative pain control by e analyzing data on pain intensity and pain characteristics
Summary
With the increasing public expectations for high quality and efficient healthcare, there is a trend that more clinicians, especially neurosurgeons, are making efforts to optimize patient outcomes by addressing pre-, peri-, and post-operative factors[1,2]. Enhanced recovery after surgery (ERAS) protocols primarily aim at optimizing outcomes, increasing patient satisfaction, and reducing health care costs[3]. Conventional perioperative care protocol is typically related to extensive preoperative preparation, significant surgical stress and prolonged time of functional recovery. With the development of perioperative pathophysiology, the concept of ERAS has been established to standardize clinical practice, improve functional capacity after surgery, speed up the patients’ rehabilitation, reduce postoperative length of stay (LOS), reduce medical cost, and improve the patients’ satisfaction[10, 11]
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