From the Guidelines
Perioperative medicine and Enhanced Recovery After Surgery (ERAS) protocols play a crucial role in optimizing patient outcomes in thoracic surgeries by reducing complications, decreasing length of stay, and improving patient satisfaction. The implementation of ERAS protocols in thoracic surgeries should be based on the most recent and highest quality evidence available. According to the study by 1, the adoption of ERAS guidelines was associated with decreased hospital length of stay and complications.
Key Components of ERAS Protocols in Thoracic Surgeries
- Preoperative optimization with smoking cessation at least 4 weeks before surgery, nutritional assessment, and carbohydrate loading (400mL of clear carbohydrate drink) 2-3 hours before surgery
- Preemptive analgesia with acetaminophen 1000mg, gabapentin 300-600mg, and celecoxib 200-400mg before surgery
- Intraoperative lung-protective ventilation strategies with tidal volumes of 4-6mL/kg, PEEP 5-8 cmH2O, and minimally invasive surgical approaches (VATS or robotic) when possible
- Multimodal analgesia including regional techniques such as thoracic epidural (for open procedures) or paravertebral blocks with 0.25% bupivacaine
- Postoperative early mobilization within 24 hours, chest tube management with digital drainage systems, early oral intake, and continued multimodal pain control with scheduled acetaminophen 1000mg every 6 hours, NSAIDs like ketorolac 15-30mg IV every 6 hours (transitioning to oral celecoxib 200mg twice daily), and opioid-sparing techniques
Benefits of ERAS Protocols in Thoracic Surgeries
- Reduced complications
- Decreased length of stay
- Improved patient satisfaction
- Minimized surgical stress response
- Reduced opioid consumption
- Promoted faster functional recovery
The study by 1 provides guidelines on enhanced recovery after pulmonary lobectomy, emphasizing the importance of a multidisciplinary approach to reduce risks and improve patient safety. The study by 1 provides recommendations for postoperative pain management after video-assisted thoracoscopic surgery. However, the most recent and highest quality study by 1 provides the strongest evidence for the implementation of ERAS protocols in thoracic surgeries. Therefore, the implementation of ERAS protocols in thoracic surgeries should be based on the guidelines provided by the most recent and highest quality study, which is the study by 1.
From the Research
Role of Perioperative Medicine and Enhanced Recovery After Surgery (ERAS) in Thoracic Surgeries
- Perioperative medicine and ERAS play a crucial role in improving patient outcomes after thoracic surgeries, with a focus on reducing complications, hospital length of stay, and costs 2, 3, 4, 5, 6
- ERAS protocols are evidence-based, multidisciplinary care models that aim to mitigate the harmful surgical stress response and accelerate functional recovery 4, 5
- The implementation of ERAS programs in thoracic surgery has been shown to improve postoperative outcomes, including reduced length of stay, morbidity, opioid use, and direct costs 2, 3, 6
Key Components of ERAS in Thoracic Surgeries
- Early removal of chest tubes and urinary catheters 6
- Early mobilization and ambulation 5, 6
- Limited use of opioids and opioid-sparing analgesia 5, 6
- Multidisciplinary care teams and evidence-based protocols 4, 6