ERAS PROTOCOLS
FOR
GENERAL SURGERY
BY:
DR.MUHAMMAD DILAWAIZ MUJAHID
ASSISTANT PROF. SURGERY. AHF
DEFINITION
ERAS refers to patient –centered ,evidence based, multidisciplinary team developed
Pathways for a surgical specialty and facility culture to reduce patients surgical
Stress response , optimize their physiologic function and facilitate recovery.
Summary of key events in the history of ERAS.
HISTORY
Advancement in Enhanced Recovery Year
Kehlet publishes paper introducing the concept of ‘fast track surgery’ [
1997
3].
Kehlet publishes first paper showing efficacy of ERAS in sigmoid
1999
resection [14].
ERAS Study Group is formed. 2001
Study shows that perioperative care is not consistent across Europe [17
2005
].
ERAS Study Group publish first consensus guidelines for colorectal
2005
surgery [19].
ERAS Society is formed. 2010
Meta-analysis shows efficacy of ERAS [20]. 2010
Study confirms findings that perioperative care is inconsistent across
2012
Europe [18].
Study assesses possibility of large-scale implementation of ERAS
2013
protocols [21].
ERAS PATHWAY
ERAS PATHWAY
Encompasses all stages of patients surgical experience:
Preoperative …. Intraoperative ….post.operative
It depends on collaborative efforts from all perioperative health care providers.
PROTOCOLS..
• Preoperative optimization:
Nutritional assessment and optimization, smoking cessation,
glycemic control, and patient education.
• Minimal invasive techniques :
Laparoscopic or Robotic surgery to reduce trauma and bleeding.
PROTOCOLS
• Enhanced pain management :
Multimodal pain control techniques to minimize opioid use and facilitate early
mobilization
• Early oral intake :
Encouraging patients to resume oral intake as soon as possible after surgery to prevent
dehydration and malnutrition
PROTOCOLS
• Early mobilization
promoting ambulation and early activity to prevent DVT and pneumonia.
• Avoid prolonged fasting :
avoid it to decrease insulin resistance after surgery and break NPO as soon as patient is out
of anesthesia
• Avoid Nasogastric tubes and drains
it helps patient early recovery
