Rowan University School of Osteopathic Medicine, Stratford, NJ, USA.
Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Neurochirurgie. 2023 Jul;69(4):101442. doi: 10.1016/j.neuchi.2023.101442. Epub 2023 Apr 14.
Postoperative complications after craniotomy for brain tumors include pain, nausea/vomiting, and infection. A standardized enhanced recovery after surgery (ERAS) protocol is not widely accepted for this common neurosurgical procedure. Few studies have explored its application.
A literature search of PubMed, Cochrane, and Google Scholar databases was performed between January 1992 and March 2023. Original studies that implemented an ERAS protocol for patients that underwent craniotomy for brain tumors were included. The following variables were evaluated: hospital length of stay (LOS), postoperative pain, postoperative nausea and vomiting (PONV) prophylaxis, non-opioid analgesia, and quality of life (QOL).
Twelve studies with a total of 1309 patients met inclusion criteria, including ten randomized controlled trials, one nonrandomized controlled trial, and one quality control study. Most frequently assessed metrics included hospital LOS, PONV prophylaxis, and non-opioid analgesia. A significant reduction in postoperative LOS was observed in 7 studies with ERAS or ERAS components. ERAS was significantly associated with pain reduction on the visual analog scale and verbal numerical rating scale (n=8). Non-opioid analgesia in ERAS improved postoperative pain control (n=4) and decreased the duration of pain (n=1). Three of six studies found no difference in PONV in ERAS vs. control. No studies reported an increase in postoperative complications using ERAS vs. control. One study showed greater patient satisfaction at 30-day follow-up with improved QOL.
Implementing ERAS protocol may enhance outcomes and quality of life in patients with moderate evidence for improved recovery in those undergoing craniotomy for brain tumors.
脑肿瘤开颅术后的并发症包括疼痛、恶心/呕吐和感染。标准化的术后加速康复（ERAS）方案并未广泛应用于这种常见的神经外科手术。很少有研究探讨其应用。
对 1992 年 1 月至 2023 年 3 月期间的 PubMed、Cochrane 和 Google Scholar 数据库进行文献检索。纳入了为接受脑肿瘤开颅术的患者实施 ERAS 方案的原始研究。评估了以下变量：住院时间（LOS）、术后疼痛、术后恶心和呕吐（PONV）预防、非阿片类镇痛药和生活质量（QOL）。
共有 12 项研究，总计 1309 例患者符合纳入标准，包括 10 项随机对照试验、1 项非随机对照试验和 1 项质量控制研究。最常评估的指标包括住院 LOS、PONV 预防和非阿片类镇痛药。有 7 项研究表明 ERAS 或 ERAS 成分可显著降低术后 LOS。ERAS 与视觉模拟量表和口头数字评分量表上的疼痛减轻显著相关（n=8）。ERAS 中的非阿片类镇痛药改善了术后疼痛控制（n=4）并缩短了疼痛持续时间（n=1）。6 项研究中有 3 项发现 ERAS 与对照组在 PONV 方面无差异。没有研究报告使用 ERAS 与对照组相比会增加术后并发症。一项研究显示，在 30 天随访时，患者满意度更高，生活质量得到改善。
实施 ERAS 方案可能会改善接受脑肿瘤开颅术患者的结局和生活质量，有中等证据表明在这些患者中可促进康复。
