The Enhanced Recovery After Surgery (ERAS) Tour

Clinical Tips and Tricks Developing Your Skills The Stitch

By: Margaret Vance, MSN, RN, CNOR, NPD-BC

Published: 6/20/2024

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Starting in 2023 and continuing into 2024, Taylor Swift’s ERAS tour has made headlines as the top grossing concert tour of all time. In perioperative care, however, ERAS has a whole different meaning. Enhanced recovery after surgery (ERAS) protocols are patient-centered, evidence-based, interdisciplinary pathways to help surgical patients achieve early recovery.1 Enjoy this Taylor Swift–inspired article to gain more insight into ERAS.

A friendship bracelet with beads that read E R A S

Postoperative recovery can have a bad reputation; however, ERAS can help patients shimmer from the beginning until postop day 22. Now let’s talk about ERAS and all the benefits for the surgical patient.

You may think you know surgery all too well; however, ERAS protocols have been built to further optimize patient recovery.2 A patient’s first experience with ERAS planning is at the time of the surgical visit. Expectations of surgery never go out of style when there is an interprofessional approach and instructions, which are individualized for a patient’s learning needs, are provided in various forms.3 Engaging family members or other patient support persons at early stages in the process also provides an added layer of support that continues outside of the hospital setting.

So, how do we get out of the woods?

Preoperatively

  • Addressing modifiable risk factors, such as smoking, alcohol and recreational drug use, nutritional intake, and exercise.2
  • Providing patients with a preoperative carbohydrate-rich drink, such as an electrolyte-filled fluid. Wait, what about midnights? Patients on ERAS protocols are often encouraged to have a carbohydrate-rich drink to address insulin resistance and potentially decrease postop nausea and vomiting (PONV).3
  • Possibly beginning venous thrombosis prophylaxis with administration of a low-molecular-weight heparin and application of sequential compression devices.4

Intraoperatively

  • Long-acting opioid pain control is moving from being the standard of care to our new ex. Alternative pain control methods, such as regional anesthesia (blocks, spinals, and epidurals), are being used in conjunction with short-acting opioids intraoperatively. Use of regional anesthesia helps to bridge the time of pain control postoperatively.3
  • Our new BFF, extended-release local anesthetics, make us say we are never getting back together with a long course of postoperative opioids. This option allows for an extended release of liposomal bupivacaine to be injected as a block for certain surgical procedures. Be cautious, though; these medications often require that no additional local anesthetics be administered within a certain timeframe after injection. Administration of additional local could cause our patients to have some bad blood and increase the patient’s risk of local anesthetic systemic toxicity (LAST).5
  • Minimally invasive surgery helps patients tolerate surgical procedures with grace. Less surgical and anesthetic time decreases the risk of further complications, such as hypothermia and surgical site infection.4
  • Administration of an intravenous antiemetic medication, such as ondansetron, can further prevent PONV while patients are still having wild dreams.3

Postoperatively

  • Shaking off feelings of PONV are necessary to ensure early ambulation and prevention of unnecessary pain from emesis.3
  • Early ambulation may leave patients with a hard time adjusting; however, trying to get up on early postop days helps to get this moving again. Early movement reduces the risk of respiratory complications and thromboembolic events and promotes a decreased length of stay.4

ERAS continues to expand to various surgical specialties and may be the single thread that ties better surgical outcomes across the perioperative patient continuum.  

References:

  1. Enhanced recovery after surgery. ERAS Society. Accessed April 30, 2024. https://erassociety.org/
  2. Jawitz OK, Bradford WT, McConnell G, Engel J, Allender JE, Williams JB. How to start an enhanced recovery after surgery cardiac program. Crit Care Clin. 2020;36(4):571–579. https://doi.org/10.1016/j.ccc.2020.07.001
  3. Schwenk W. Optimized perioperative management (fast-track, ERAS) to enhance postoperative recovery in elective colorectal surgery. GMS Hyg Infect Control. 2022;17. https://doi.org/10.3205/dgkh000413
  4. Croke L. Expanded indications and enhanced recovery protocols for bariatric surgery. AORN J. 2023;118(3):P4-P6. https://doi.org/10.1002/aorn.13994
  5. Davidson VL, McGrath MC, Navarro S. Preventing local anesthetic systemic toxicity after administration of long-acting local anesthetics. AORN J. 2024;119(2):164-168. https://doi.org/10.1002/aorn.14085

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