Newsletter

[ Vol. 11 No. 1 ] (January - April 2010 )
Best practice in perioperative care -eras

Olle Ljungqvist
Karolinska Institutet, Stockholm, Sweden

ERAS is the abbreviation for Enhanced Recovery After Surgery. The ERAS study group founded this term a few years ago to name a preoperative treatment plan to improve recovery after surgery. The ERAS study group spent about a year to study the literature about each and every detail of the perioperative care process. The evidence base achieved formed the basis for the treatment program that was launched in 2002/2003 and later published (Fearon, Ljungqvist et al. 2005). This treatment plan is constantly reviewed and updated as novel information is developed, and hence an update of the protocol is in press in Archives of Surgery at the moment. The overall program is quite different from traditional care, since it proved that many of the traditional treatments are actually harmful for the patient.

The ERAS protocol is based on the philosophy that the stress that surgery induces should be reduced to a minimum. An important tool is the use of continuous epidural analgesia activated before the onset of surgery and continued for 2-3 days after the operation. At the same time, treatments that support the return of basic functions should be supported. These basic goals are embedded into the protocol so that patients, journey through the pre-, per- and post-operative care is as smooth as possible. The program challenges many of the old traditions such as preoperative bowel cleansing, preoperative fasting, strong pre medications, avoiding fluid overloading during and after surgery, postoperative fasting, gastric tubes and nil per os for days. Instead the program from the evidence in the literature tells us that patients should not have bowel preparation as a routine before colon resections. They should be given a preoperative carbohydrate drink two hours before surgery. They should be given about 2 l of total fluids during the day of surgery using a mixture of colloids and cristalloids. They should not have nasogastric tubes after surgery and nutritional supplements commenced within a couple of hours after surgery. Dinner can be given on the same day if tolerated. They should be out of bed for at least 2 h the day after surgery, drips should be taken down as a routine the day after the operation and from then on patients should have food and drinks ad libitum along with 2 packs of protein-rich supplements. They should be mobilized 6 h out of bed per day thereafter. Pain relief is secured by the use of local anesthetics in the epidural complemented by paracetamol and cox 2 inhibitors.

• Fearon, K. C., O. Ljungqvist, et al. (2005). “Enhanced recovery after surgery: A consensus review of clinical care for patients undergoing colonic resection.“ Clin Nutr 24(3): 466-77.

From   
PENSA 2009
“Energizing Nutrition Support Practice for Life”
June 5-7 2009, Shangri-La Hotel, Kuala Lumpur, Malaysia 
Page: 49