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Enhanced recovery after surgery and anesthetic outcomes in pediatric reconstructive urologic surgery
Daniel S Han1, Megan A Brockel2, Peter J Boxley3
1Department of Pediatric Urology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E. 16th Ave, B-463, Aurora, CO, 80045, USA. daniel.han@childrenscolorado.org.
Insights
Enhanced recovery after surgery (ERAS) protocols reduced pain and opioid use in pediatric urologic surgery patients. This strategy improved anesthetic outcomes, showing promise for enhanced postoperative recovery in children.
Area of Science:
- Pediatric Anesthesiology
- Surgical Recovery Protocols
- Pain Management
Background:
- Enhanced Recovery After Surgery (ERAS) is a perioperative strategy to improve patient recovery.
- Its application in pediatric surgical populations, particularly for complex procedures like urologic reconstruction with bowel anastomosis, is an area of ongoing research.
- Optimizing anesthetic and analgesic management is crucial for pediatric surgical outcomes.
Purpose of the Study:
- To evaluate the impact of a pilot Enhanced Recovery After Surgery (ERAS) protocol on anesthetic outcomes in pediatric patients undergoing urologic reconstruction.
- To compare pain scores, opioid requirements, and other anesthetic-related parameters between ERAS patients and historical controls.
Main Methods:
- A prospective case-control study was conducted involving pediatric patients (<18 years) undergoing urologic reconstruction with bowel anastomosis.
- The ERAS protocol included multimodal analgesia, opioid minimization, and routine nausea/vomiting prophylaxis.
- ERAS patients were propensity-matched with historical controls, and outcomes such as maximum PACU pain score and time to first opioid were analyzed.
Main Results:
- The ERAS group showed a significant increase in patients receiving no intraoperative or postoperative opioids (0% vs 15%, p=0.046).
- Maximum PACU pain scores were significantly reduced in the ERAS group (3 vs 0, p<0.001).
- Postoperative supplemental oxygen use decreased in the ERAS group (85% vs 38%, p=0.013).
Conclusions:
- Implementation of an ERAS protocol in pediatric urologic reconstructive surgery with bowel anastomosis appears effective.
- ERAS protocols significantly decrease postoperative pain and opioid usage in this patient population.
- The findings suggest ERAS positively impacts other anesthetic outcomes, contributing to improved pediatric surgical recovery.
Purpose:
Enhanced recovery after surgery (ERAS) is a perioperative management strategy to hasten postoperative recovery. We examined the effects of a pilot implementation of ERAS for pediatric patients on anesthetic outcomes.
Methods:
We performed a prospective case-control study utilizing an ERAS protocol in patients aged < 18 years undergoing urologic reconstruction that included a bowel anastomosis. Protocol elements included: multimodal analgesia, opioid minimization, and routine nausea/vomiting prophylaxis. ERAS patients were propensity-matched with historical controls. Outcomes of interest included maximum PACU pain score, time to first opioid, opioid-free days, and need for opioids on day of discharge.
Results:
A total of 13 ERAS patients and 26 historical controls were included, with median ages 9.9 years (IQR 9.1-11) and 10.4 years (IQR 8.0-12.4), respectively. ERAS increased the percentage of patients who did not receive any intraoperative or postoperative opioids (0% vs 15%, p = 0.046 for both) and reduced maximum PACU pain score (3 vs 0, p < 0.001). The use of postoperative supplemental oxygen was decreased in the ERAS group (85% vs 38%, p = 0.013).
Conclusions:
The implementation of an ERAS protocol appears to decrease postoperative pain, opioid usage, and positively impact other anesthetic outcomes in children undergoing urologic reconstructive surgery utilizing a bowel anastomosis.
