ERAS (Enhanced Recovery After Surgery)

1. What is ERAS? 
Enhanced Recovery After Surgery 

2. How long has it been around? 
Almost 3 decades

3. Where did it originate? 
In Denmark, Henrik Kehlet, a colorectal surgeon, identified steps to improve patients' outcomes, reduce their hospital stay and improve their overall recovery.

4. Why use ERAS protocols?
An ERAS protocol is a partnership between you and your healthcare team to reduce your chances of complications and help you recover quickly from surgery. The main purpose of ERAS is to get you back to your normal activities as soon as possible after surgery.
We will work together to: 

  • Address your concerns and questions
  • Decrease your risk of post-operative complications including nausea and vomiting
  • Control your pain
  • Help you move and walk after surgery

5. Is ERAS a research study?
No. ERAS is a combination of best practices for perioperative care. 

6. How can I get involved? 
When you run a marathon, you prepare long and hard. To your body, surgery can be like a marathon, so you should approach it with the same conscientiousness. 

  • Eat a healthy balanced diet rich in protein, vitamins and minerals
  • Exercise - increase your activity each day leading up to surgery
  • Be compliant with your medications - see you doctor if your medical conditions are not controlled
  • Be compliant with your CPAP if you use one
  • Lose weight if your BMI is over 25 - **what is my BMI?
  • Stop smoking today
  • Cut back on alcohol consumption / Avoid drugs of abuse - these may need medical supervision if you have a substance use disorder/ heavy use

7. What should I expect before surgery?
At your surgeon’s office we will discuss the Enhanced Recovery pathway with you. You will receive a patient booklet and diary. Please take time to read through this booklet and document any questions. 

At your Pre-Operative Services visit we will give you special scrubs to wash with. Some surgeries will receive a specific carbohydrate drink and / or a breathing exercise device (incentive spirometer). The drink/ incentive spirometer and instructions will be given to you at this visit, if applicable.

8. What is multimodal analgesia?
Pain control without over sedation and without causing nausea and/or vomiting are crucial components of the ERAS pathway. Multimodal analgesia uses different medications and techniques that act at different sites to control pain. This allows lower doses and less side effects. Included are NSAID1s, acetaminophen, local anesthetics, opiates and simple, effective measures such as ice.

1. Non- Steroidal Anti-Inflammatory Drugs

9. What is a nerve block? 
Some surgical pain is best treated with a nerve block. Nerve blocks inject numbing medications near specific nerves to decrease pain during and after surgery. This may be used along with general anesthesia. Your anesthesiologist will discuss the best option for you.
Examples of nerve blocks include epidurals, spinals, and local anesthetics. 

10. What is an epidural?
An epidural for pain management is tiny soft catheter(tube) that is placed in the epidural space surrounding the spinal cord in your back. The nerves that supply the feelings of sensation and pain start in the spinal cord and pass through the epidural space. Medication administered through this catheter is used to numb the nerves as they pass through. Pain is blocked for as long as medication is given through the catheter. The site of the surgery will determine which nerves need to be blocked and as such, the site of the epidural. Epidural pain control allows pain control with less side effects.

11. When will my epidural be put in?
If appropriate for you an epidural will be placed by our acute pain management team before you come to the operating room.

They will give you medication to help you relax. Being relaxed will help you stay in the right position while your epidural is being put in. To place the epidural catheter, we ask you to sit up with your shoulders and upper back curved forward. It is important for you to sit very still while the epidural is being placed. You may feel the pinch of local anesthetic used for numbing your skin – after that usually only some pressure at the site

The catheter is left in – usually overnight allowing for medication to be infused to numb the appropriate area. Removing the catheter entails removing that dressing the sticks it to your skin – it all comes off/out together and is not painful.

12. What should I expect after surgery? 
Surgeries vary but in general you should expect to:

  • Get up and out of bed as soon as the day of surgery
  • Eat and drink as soon as the day of surgery
  • Have pain that is tolerable and doesn't prevent you from breathing comfortably and moving around.
  • Increase your activity level each day 
  • Support from your surgical, anesthesia and nursing teams to achieve these goals

For more information on the Stony Brook Anesthesia ERAS program click on the link: https://renaissance.stonybrookmedicine.edu/anesthesiology/eras