All India Institute of Medical Sciences, Bhubaneswar, India.
Department of Anesthesia and Critical Care, AIIMS Bhubaneswar, Bhubaneswar, India.
BMC Neurol. 2021 Mar 19;21(1):127. doi: 10.1186/s12883-021-02150-7.
Enhanced Recovery After Surgery (ERAS) is a multimodal perioperative care bundle aimed at the early recovery of patients. Well accepted in gastric and pelvic surgeries, there is minimal evidence in neurosurgery and neurocritical care barring spinal surgeries. We wished to compare the length of intensive care unit (ICU) or high dependency unit (HDU) stay of patients undergoing elective craniotomy for supratentorial neurosurgery: ERAS protocol versus routine care. The secondary objective was to compare the postoperative pain scores, opioid use, glycemic control, and the duration of postoperative hospital stay between the two groups.
In this pragmatic non-randomized controlled trial (CTRI/2017/07/015451), consenting adult patients scheduled for elective supratentorial intracranial tumor excision were enrolled prospectively after institutional ethical clearance and consent. Elements-of-care in the ERAS group were- Preoperative -family education, complex-carbohydrate drink, flupiritine; Intraoperative - scalp blocks, limited opioids, rigorous fluid and temperature regulation; Postoperative- flupiritine, early mobilization, removal of catheters, and initiation of feeds. Apart from these, all perioperative protocols and management strategies were similar between groups. The two groups were compared with regards to the length of ICU stay, pain scores in ICU, opioid requirement, glycemic control, and hospital stay duration. The decision for discharge from ICU and hospital, data collection, and analysis was by independent assessors blind to the patient group.
Seventy patients were enrolled. Baseline demographics - age, sex, tumor volume, and comorbidities were comparable between the groups. The proportion of patients staying in the ICU for less than 48 h after surgery, the cumulative insulin requirement, and the episodes of VAS scores > 4 in the first 48 h after surgery was significantly less in the ERAS group - 40.6% vs. 65.7%, 0.6 (±2.5) units vs. 3.6 (±8.1) units, and one vs. ten episodes (p = 0.04, 0.001, 0.004 respectively). The total hospital stay was similar in both groups.
The study demonstrated a significant reduction in the proportion of patients requiring ICU/ HDU stay > 48 h. Better pain and glycemic control in the postoperative period may have contributed to a decreased stay. More extensive randomized studies may be designed to confirm these results.
Clinical Trial Registry of India ( CTRI/2018/04/013247 ), registered retrospectively on April 2018.
加速康复外科（ERAS）是一种多模式围手术期护理方案，旨在促进患者的早期康复。该方案在胃和盆腔手术中得到广泛认可，但在神经外科和神经重症监护领域的证据有限，除了脊柱手术之外。我们希望比较接受择期颅顶神经外科开颅手术的患者在重症监护病房（ICU）或高依赖病房（HDU）的停留时间：ERAS 方案与常规护理。次要目标是比较两组患者术后疼痛评分、阿片类药物使用、血糖控制和术后住院时间。
在这项实用的非随机对照试验（CTRI/2017/07/015451）中，经机构伦理审查和同意后，前瞻性纳入了计划接受择期颅顶颅内肿瘤切除术的成年患者。ERAS 组的护理要素包括：术前——家庭教育、复合碳水化合物饮料、氟比洛芬酯；术中——头皮阻滞、限制阿片类药物、严格的液体和体温调节；术后——氟比洛芬酯、早期活动、导管拔除和开始喂养。除了这些，两组之间的所有围手术期方案和管理策略都是相似的。两组患者在 ICU 停留时间、ICU 疼痛评分、阿片类药物需求、血糖控制和住院时间方面进行比较。ICU 出院和医院出院的决策、数据收集和分析由对患者分组不知情的独立评估者进行。
共纳入 70 例患者。两组患者的基线人口统计学特征——年龄、性别、肿瘤体积和合并症相似。术后 ICU 停留时间<48 小时、累积胰岛素需求和术后 48 小时内 VAS 评分>4 的患者比例在 ERAS 组明显较低——40.6% vs. 65.7%、0.6（±2.5）单位 vs. 3.6（±8.1）单位和 1 次 vs. 10 次（p=0.04、0.001、0.004）。两组患者的总住院时间相似。
该研究表明，需要 ICU/HDU 入住>48 小时的患者比例显著降低。术后疼痛和血糖控制的改善可能导致住院时间缩短。可能需要设计更广泛的随机研究来证实这些结果。
印度临床试验注册中心（CTRI/2018/04/013247），于 2018 年 4 月进行回顾性注册。
