Récupération améliorée après chirurgie (RAAC) thoracique

Abstract

Enhanced Recovery after Surgery (ERAS) is a multidisciplinary approach with global patient management in the perioperative period, with the aim of a fast recovery of all his/her physical and psychic abilities. An ERAS program needs to reorganization of the clinical care delivered by all caregivers, positioning the patient at the center of their work. An ERAS program needs the definition of a detailed clinical path, from the very first medical consultation to the hospitalization exit. The patient should become an actual actor of his/her own care, since involved in this path from the pre-operative period. ERAS comprises a preoperative (oral semi-intense nutrition, tobacco smoking quitting, short preoperative fasting …), along with pain control, nausea and vomiting control, control of metabolic, physical and psychological stress, combat against per-operative hypothermia, struggle against over-medicalization (nasogastric or urinary tubes, central venous lines, multiple and long chest drainages …), per-operative loco-regional efficient analgesia, and limitation of perioperative over-infusions. ERAS should lead non only to a better patient satisfaction, but also to a decrease of post-operative complications, with a fast activity resuming, allowed by an efficient multimodal post-operative analgesia, sparing opioids use, without impairing early mobilization and physiotherapy.1877-1203/© 2022 SPLF. Published by Elsevier Masson SAS. All rights reserved.