"Enhanced recovery after surgery - ERAS in elective craniotomies-a non-randomized controlled trial"

Area of Science:

• Neurosurgery
• Critical Care Medicine
• Perioperative Medicine

Background:

• Enhanced Recovery After Surgery (ERAS) is a perioperative care bundle with established benefits in various surgical fields.
• Evidence for ERAS in neurosurgery, particularly for supratentorial procedures, is limited.
• This study investigated the efficacy of ERAS in neurocritical care settings.

Purpose of the Study:

• To compare the length of ICU/HDU stay between ERAS protocol and routine care for elective supratentorial neurosurgery.
• To evaluate secondary outcomes including postoperative pain, opioid use, glycemic control, and hospital stay duration.

Main Methods:

• A pragmatic, non-randomized controlled trial involving adult patients undergoing elective supratentorial tumor excision.
• ERAS protocol included preoperative education, carbohydrate drinks, flupiritine; intraoperative scalp blocks, limited opioids, fluid/temperature management; and postoperative flupiritine, early mobilization, and feeding.
• Outcomes were compared by independent assessors blinded to group allocation.

Main Results:

• The ERAS group showed a significantly lower proportion of patients requiring ICU/HDU stay >48 hours (40.6% vs. 65.7%).
• ERAS significantly reduced cumulative insulin requirements (0.6 vs. 3.6 units) and episodes of severe pain (VAS >4) in the first 48 hours (1 vs. 10 episodes).
• Total hospital stay duration was comparable between the ERAS and routine care groups.

Conclusions:

• The ERAS protocol significantly reduced the need for prolonged ICU/HDU stays in patients undergoing supratentorial neurosurgery.
• Improved postoperative pain and glycemic control appear to be key factors contributing to the reduced ICU/HDU stay.
• Further extensive randomized studies are recommended to validate these findings.