СOMPLEX APPLICATION OF THE ADAPTED ENHANCE RECOVERY AFTER SURGERY PROGRAMME IN CHILDREN UNDERGOING ORTHOPAEDIC SURGERY

Abstract

The current concept of Enhance Recovery After Surgery (ERAS) is widely used in adults, but it still remains unexplored in children.Goal of the study. To evaluate the efficacy of the complex application of ERAS programme in children undergoing orthopaedic surgery. Materials and methods. This is a prospective randomized study included 47 patients aged 1-17 years old. The ERAS programme was applied to 22 patients in the study group and it consisted of the following pathways: informing of patients and their parents, avoiding bowel preparation before the surgery, full feeding on the day before surgery and administration of clear carbohydrate drink 2 hours prior induction of anaesthesia, minimization of surgery, regional anaesthesia techniques, postoperative nausea and vomiting (PNV) prophylactics, avoiding opioids perioperatively, euvolemic infusion strategy, normothermia, early postoperative feeding, early postoperative verticalization and mobilization in the 1st postoperative day, no drains and catheters, determining of criteria for safe discharge. Patients in control group (n=25) we did not apply the whole complex of ERAS pathways, but managed them in according to the current recommendations for preoperative fasting, PNV prophylactics, intraoperative fluid therapy, and surgery was also minimized. The primary outcome was the length of stay (LOS) in the hospital up to achieving of discharge criteria. Secondary outcomes were orthostatic tolerance and activity in the 1st postoperative day and patients’ wellbeing (10-point scale) next morning after surgery. Results of the study. LOS was significantly low in the study group (5,6 ± 3,4 vs. 8,9 ± 3,5, р=0,002). All patients (100%) in the study group and 19 patients in the control group successfully took a vertical position on the 1st day after surgery. Patients’ wellbeing in the morning of the next day after surgery was rated as 7,86 ± 1,61 in the study group and 6,52 ± 1,81 in the control group (р=0,01).Conclusions. The results of the study suggests the positive impact of the complex application of ERAS programme on wellbeing and activity of patients and reduced LOS in children in orthopaedic surgery.