Less Is More: A Minimalist Enhanced Recovery After Surgery Protocol for Pediatric Plastic Surgery in an International...

Area of Science:

• Plastic Surgery
• Pediatric Surgery
• Anesthesiology

Background:

• Enhanced Recovery After Surgery (ERAS) protocols have transformed perioperative care.
• ERAS principles applied to cleft surgery show positive results like reduced opioid use and shorter hospital stays.
• The effectiveness of ERAS in resource-limited settings remains largely untested.

Purpose of the Study:

• To design and implement a minimalist ERAS protocol for pediatric craniofacial surgery in an international, resource-limited setting.
• To evaluate the outcomes of this simplified ERAS protocol.
• To challenge the assumption that complex protocols are necessary for enhanced recovery.

Main Methods:

• A deliberately minimalist ERAS protocol was developed and implemented over several years.
• The protocol included intraoperative local anesthetic, prophylactic dexamethasone, and scheduled acetaminophen and ibuprofen postoperatively.
• Forty-seven pediatric craniofacial operations were performed using this simplified regimen.

Main Results:

• Highly favorable outcomes were achieved despite the absence of adjunctive agents or postoperative opioids.
• Mean pain scores were low (1.9/10 on the Wong-Baker FACES scale).
• First oral intake occurred early (6.5 hours), and hospital length of stay was under 24 hours, with no readmissions or acute complications.

Conclusions:

• A simplified, evidence-based ERAS protocol can achieve outcomes equivalent or superior to complex protocols.
• Minimalist and cost-conscious ERAS protocols are feasible for broad implementation, especially in resource-limited institutions.
• This study supports the wider application of enhanced recovery principles globally, enhancing accessibility in diverse healthcare environments.