Monitored Anesthetic Care Combined with Scalp Nerve Block in Awake Craniotomy: an Effective Attempt at Enhanced Recovery after Neurosurgery.

Abstract

BACKGROUND\nEnhanced recovery after surgery is currently being attempted in neurosurgery increased at a greater rate. There is a lot of concern about the feasibility of enhanced recovery after neurosurgery (ERANS). How to manage the available resources to safely perform ERANS for improving clinical outcomes is the subject of much debate and discussion.\n\n\nMETHODS\nThere is paucity of data on ERANS in this feasibility study which reports outcomes of the protocols utilized within a tertiary-referral neurosurgery center. Data on the patients undergoing awake craniotomy within an ERANS protocol were prospectively recorded in our institution from Sep., 2017 to Dec., 2018. Then we evaluate the safety and effectiveness of the novel ERANS.\n\n\nRESULTS\nA total of 20 procedures (age [mean ± SD], 49.5±17.8 years) were undertaken. Intraoperative Hypertension, Hypotension and Bradycardia were present in 4 (20%), 1 (5%), 1 (5%) patients, respectively. Postoperative morbidities include epilepsy (1, 5%), pain (3, 15%) and nausea or vomiting (2, 10%). There were no significant changes in mean arterial pressure, heart rate, blood glucose and lactic acid throughout the procedure. The median length of intensive care unit stay and postoperative hospital stay were 1 day and 9.5 days, respectively. No 30-days readmission or reoperation occurred in this study.\n\n\nCONCLUSION\nApplying an ERANS protocol was feasible, associated with low incidence of complications and acceptable intensive care unit and postoperative hospital length of stay. The finding of the current study may provide a new approach for the further research of ERANS.