Enhanced recovery after surgery (ERAS)…. still a distant speck on the horizon !

Abstract

© 2021 Indian Journal of Anaesthesia | Published by Wolters Kluwer Medknow Enhanced recovery after surgery (ERAS) is a protocolised scientific pathway consisting of multimodal evidence-based strategies at every step of perioperative care to reduce the surgical stress response by modifying the inflammatory and metabolic changes.[1] Professor Henrik Kehlet first initiated the concept of ERAS in the late 1990s.[2] ERAS is well established in specialities like colorectal, thoracic, vascular, urological, and being extended to many other surgeries. ERAS protocols (also called as ERAS care, ERAS pathway) primarily originated from modifications within the individual conventional perioperative care strategies in the hospital setting. In the year 2009, Lassen et al. published the first ERAS Group recommendations which was a comprehensive evidence-based, multimodal consensus review describing perioperative care for colorectal surgery.[3] The updated review was last published in 2019 by Gustafsson et al.[4] Various evidence-based protocols are being established for elective surgeries with limitations to patient with multiple comorbid conditions and emergency surgeries. Anaesthesia techniques primary involve opioid sparing anaesthesia, central neuraxial block, especially epidural anaesthesia, various ultrasonography (USG)-guided nerve blocks and nonopioid analgesics. Use of less sedative pre-anaesthetic drugs, shorter acting sedatives also help in early recovery from anaesthesia. The use of inhalational anaesthetics like sevoflurane, desflurane with depth of anaesthesia and neuromuscular monitoring is now a part of standard care for ERAS protocol when general anaesthesia is instituted. Various nerve blocks commonly used are epidural, paravertebral block, transverse abdominis plane (TAP) block, rectus sheath block, spinal (anaesthesia), pectoral nerve (PECs) block, serratus plane blocks, erector spinae plane (ESP) block, and wound catheter for abdominal and thoracic operations. ERAS which started for colorectal surgeries now has applications in all surgeries including bariatric, neonatal, obstetric, cardiovascular and arthroplasties.[5]