Barrette Louis-Xavier, Cohen William G, Chao Tiffany, Douglas Jennifer E, Kearney James, Thaler Erica, Kohanski Michael A, Adappa Nithin, Palmer James N, Rajasekaran Karthik
Department of Otorhinolaryngology-Head and Neck Surgery University of Pennsylvania Philadelphia Pennsylvania USA.
Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia Pennsylvania USA.
World J Otorhinolaryngol Head Neck Surg. 2024 Mar 21;11(1):147-157. doi: 10.1002/wjo2.166. eCollection 2025 Mar.
Enhanced recovery after surgery (ERAS) protocols for endoscopic sinus surgery (ESS) have not been widely implemented, and a critical review of ERAS recommendations and a comprehensive analysis of the supporting literature has not been undertaken. We describe an ESS ERAS protocol including key perioperative interventions for patients undergoing ESS and assess the available evidence.
A search was conducted of all relevant ERAS literature in otorhinolaryngology, anesthesia, and surgery using Medline (via PubMed), and Scopus. Keywords included "endoscopic sinus surgery," "sinus surgery," "FESS," and "ESS" for each area of intervention. Where applicable, the authors considered high-level evidence for recommendations devised for patient cohorts in otorhinolaryngology not undergoing ESS, as well as cohorts undergoing surgical procedures for which ERAS protocols have been extensively evaluated.
Studies received grades of "low," "moderate," or "high" quality evidence based on the Oxford Centre for Evidence-Based Medicine criteria. Each intervention was subsequently assigned a grade of "strong," "weak," or "conditional" based on the available evidence.
Strong recommendations include comprehensive patient education and counseling, minimization of preoperative fasting, application of topical/local anesthetics and vasoconstrictors, use of total intravenous anesthesia, avoidance of pharyngeal packing, and use of postoperative nasal irrigation and multimodal analgesia. Conditional recommendations include antibiotic prophylaxis. Weak recommendations include perioperative venous thromboembolism prophylaxis, controlled hypotension, and use of postoperative nasal packing/dressing.
A comprehensive ERAS protocol for ESS can include a variety of high yield, evidence-based interventions that would likely improve surgical outcomes and patient satisfaction.
内镜鼻窦手术（ESS）的术后加速康复（ERAS）方案尚未得到广泛实施，且尚未对ERAS建议进行批判性审查以及对相关文献进行全面分析。我们描述了一种ESS的ERAS方案，包括针对接受ESS患者的关键围手术期干预措施，并评估现有证据。
使用Medline（通过PubMed）和Scopus对耳鼻咽喉科、麻醉学和外科学中所有相关的ERAS文献进行检索。每个干预领域的关键词包括“内镜鼻窦手术”“鼻窦手术”“功能性内镜鼻窦手术（FESS）”和“ESS”。在适用的情况下，作者考虑了为未接受ESS的耳鼻咽喉科患者队列以及已对ERAS方案进行广泛评估的手术队列所制定建议的高级别证据。
根据牛津循证医学中心的标准，研究被评为“低”“中”或“高”质量证据。随后根据现有证据为每个干预措施赋予“强”“弱”或“有条件”的等级。
强推荐包括全面的患者教育和咨询、术前禁食时间最短化、局部/表面麻醉剂和血管收缩剂的应用、全静脉麻醉的使用、避免咽部填塞以及术后鼻腔冲洗和多模式镇痛的使用。有条件推荐包括抗生素预防。弱推荐包括围手术期静脉血栓栓塞预防、控制性低血压以及术后鼻腔填塞/敷料的使用。
ESS的综合ERAS方案可包括多种高收益、基于证据的干预措施，这可能会改善手术效果和患者满意度。
