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Abstract
BackgroundInfratentorial craniotomy patients have a high incidence of postoperative nausea and vomiting (PONV). Enhanced Recovery After Surgery (ERAS) protocols have been shown in multiple surgical disciplines to improve outcomes, including reduced PONV. However, very few studies have described the application of ERAS to infratentorial craniotomy. The aim of this study was to examine whether our ERAS protocol for infratentorial craniotomy could improve PONV.MethodsWe implemented an evidence-based, multimodal ERAS protocol for patients undergoing infratentorial craniotomy. A total of 105 patients who underwent infratentorial craniotomy were randomized into either the ERAS group (n = 50) or the control group (n = 55). Primary outcomes were the incidence of vomiting, nausea score, and use of rescue antiemetic during the first 72 h after surgery. Secondary outcomes included postoperative anxiety level, sleep quality, and complications.ResultsOver the entire 72 h post-craniotomy observation period, the cumulative incidence of vomiting was significantly lower in the ERAS group than in the control group. Meanwhile, the incidence of vomiting was significantly lower in the ERAS group on postoperative days (PODs) 2 and 3. Notably, the proportion of patients with mild nausea (VAS 0–4) was higher in the ERAS group as compared to the control group on PODs 2 or 3. Additionally, the postoperative anxiety level and quality of sleep were significantly better in the ERAS group.ConclusionSuccessful implementation of our ERAS protocol in infratentorial craniotomy patients could attenuate postoperative anxiety, improve sleep quality, and reduce the incidence of PONV, without increasing the rate of postoperative complications.Trial registrationChiCTR-INR-16009662, 27 Oct 2016, Clinical study on the development and efficacy evaluation of Enhanced Recovery After Surgery (ERAS) in Neurosurgery.
Highlights
Infratentorial craniotomy patients have a high incidence of postoperative nausea and vomiting (PONV)
The postoperative anxiety level and quality of sleep were significantly better in the Enhanced Recovery After Surgery (ERAS) group
We investigated whether the ERAS protocol was superior to conventional perioperative management in infratentorial craniotomy patients
Summary
Infratentorial craniotomy patients have a high incidence of postoperative nausea and vomiting (PONV). The aim of this study was to examine whether our ERAS protocol for infratentorial craniotomy could improve PONV. Previous reports indicated that significant improvements in postoperative recovery can be achieved by implementing a standardized protocol of evidence-based treatments over the entire perioperative period [3, 4]. This concept of enhanced recovery after surgery (ERAS) was originally conceptualized by Kehlet to improve functional outcomes after surgery and decrease perioperative morbidity [5, 6]. Hagan et al proposed some key components of ERAS applicable to craniotomy based on evidence available from other surgical specialties [10]
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