Enhanced Recovery After Surgery (ERAS): What the Evidence Shows and the Role of the CRNA in its Success (1 Class A CE with .5 Pharm)

Enhanced Recovery After Surgery (ERAS) is an evidence-based, multidisciplinary and collaborative approach to care for patients undergoing colorectal, gynecologic-oncology, and other major surgeries to expediate their return to their preoperative baseline. It is based on complimentary principles to: 1) optimize perioperative nutrition, 2) standardize anesthetic management including fluid/intravascular volume administration informed by goal directed fluid therapy, 3) control perioperative pain emphasizing non-opioid analgesia, 4) mitigate the physiologic stress response to surgery, and 5) promote early mobilization and oral intake. ERAS pathways demonstrated conclusively to decrease length of stay, show decreased or comparable perioperative morbidity and readmissions, while improving patient satisfaction and reducing hospital costs. The greater the adherence to the components of ERAS guidelines, the greater the outcomes for the patient.

The evidence on the tenets of ERAS will be presented in each stage of perioperative management, preoperative, intraoperative, and postoperative with an emphasis on the preoperative and intraoperative opioid-sparing multimodal approach to analgesia and inhibition of the surgical stress response. Each medication’s mechanism, site of action, and their role in the prevention of pain pathophysiology such as hyperalgesia, central sensitization, and windup will be presented.

ERAS protocols will be presented utilizing both case studies and data for colo-rectal surgery,
laparoscopic donor nephrectomy, and mastectomy surgeries. These protocols demonstrate the overwhelming benefit to the surgical patient and are applicable with some modifications to other surgical procedures.