Management of Postoperative Pain after Elective Craniotomy: A Prospective Randomized Controlled Trial of a Neurosurgical Enhanced Recovery after Surgery (ERAS) Program

Qu, Liang; Liu, Bolin; Zhang, Haitao; Sankey, Eric W.; Chai, Wei; Wang, Binrong; Li, Zhengmin; Niu, Jiangtao; Zhao, Binfang; Jiang, Xue; Ye, Lin; Zhao, Lanfu; Zhang, Yufu; Zheng, Tao; Xue, Yafei; Chen, Lei; Chen, Long; Han, Haijing; Liu, Wenjuan; Li, Ruigang; Gao, Guodong; Wang, Xuelian; Wang, Yuan; He, Shiming

doi:10.7150/ijms.46403

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Int J Med Sci 2020; 17(11):1541-1549. doi:10.7150/ijms.46403 This issue Cite

Research Paper

Management of Postoperative Pain after Elective Craniotomy: A Prospective Randomized Controlled Trial of a Neurosurgical Enhanced Recovery after Surgery (ERAS) Program

Liang Qu^1*, Bolin Liu^2*, Haitao Zhang³, Eric W. Sankey⁷, Wei Chai⁴, Binrong Wang⁴, Zhengmin Li⁵, Jiangtao Niu⁵, Binfang Zhao¹, Xue Jiang¹, Lin Ye⁶, Lanfu Zhao¹, Yufu Zhang¹, Tao Zheng², Yafei Xue¹, Lei Chen², Long Chen¹, Haijing Han², Wenjuan Liu², Ruigang Li², Guodong Gao¹, Xuelian Wang¹, Yuan Wang^1✉, Shiming He^2✉

1. Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University. Xi'an, China.
2. Department of Neurosurgery, Xi'an International Medical Center, Xi'an, Shaanxi, China.
3. Department of Respiratory and Critical Care Medicine, Tangdu Hospital, Fourth Military Medical University. Xi'an, China.
4. Department of Anesthesiology, Xi'an International Medical Center, Xi'an, Shaanxi, China.
5. Department of Anesthesiology, Tangdu Hospital, Fourth Military Medical University. Xi'an, China.
6. Department of Nutrition, Tangdu Hospital, Fourth Military Medical University. Xi'an, China.
7. Duke University Hospital. Durham, NC. USA.
*These authors contributed equally in this study.

Citation:

Qu L, Liu B, Zhang H, Sankey EW, Chai W, Wang B, Li Z, Niu J, Zhao B, Jiang X, Ye L, Zhao L, Zhang Y, Zheng T, Xue Y, Chen L, Chen L, Han H, Liu W, Li R, Gao G, Wang X, Wang Y, He S. Management of Postoperative Pain after Elective Craniotomy: A Prospective Randomized Controlled Trial of a Neurosurgical Enhanced Recovery after Surgery (ERAS) Program. Int J Med Sci 2020; 17(11):1541-1549. doi:10.7150/ijms.46403. https://www.medsci.org/v17p1541.htm

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Abstract

Objective: To prospectively evaluate the efficacy of a neurosurgical enhanced recovery after surgery (ERAS) protocol on the management of postoperative pain after elective craniotomies.

Methods: This randomized controlled trial was conducted in the neurosurgical center of Tangdu Hospital (Fourth Military Medical University, Xi'an, China). A total of 129 patients undergoing craniotomies between October 2016 and July 2017 were enrolled in a randomized clinical trial comparing an ERAS protocol to a conventional postoperative care regimen. The primary outcome was the postoperative pain score assessed by a verbal numerical rating scale (NRS).

Results: Patients in the ERAS group had a significant reduction in their postoperative pain scores on POD 1 compared to patients in the control group (p < 0.05). More patients (n = 44, 68.8%) in the ERAS group experienced mild pain (NRS: 1 to 3) on POD1 compared with patients (n = 23, 35.4%) in the control group (p < 0.05). A further reduction in pain scores was also observed on POD 2 and maintained on POD 3 in the ERAS group compared with that in the control group. In addition, the median postoperative length of hospital stay was significantly decreased with the incorporation of the ERAS protocol compared to controls (ERAS: 4 days, control: 7 days, P<0.001).

Conclusion: The implementation of a neurosurgical ERAS protocol for elective craniotomy patients has significant benefits in alleviating postoperative pain and enhancing recovery leading to early discharge after surgery compared to conventional care. Further evaluation of this protocol in larger, multi-center studies is warranted.

Keywords: Enhanced recovery after surgery (ERAS), neurosurgery, elective craniotomy, pain management, outcomes

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APA

Qu, L., Liu, B., Zhang, H., Sankey, E.W., Chai, W., Wang, B., Li, Z., Niu, J., Zhao, B., Jiang, X., Ye, L., Zhao, L., Zhang, Y., Zheng, T., Xue, Y., Chen, L., Chen, L., Han, H., Liu, W., Li, R., Gao, G., Wang, X., Wang, Y., He, S. (2020). Management of Postoperative Pain after Elective Craniotomy: A Prospective Randomized Controlled Trial of a Neurosurgical Enhanced Recovery after Surgery (ERAS) Program. International Journal of Medical Sciences, 17(11), 1541-1549. https://doi.org/10.7150/ijms.46403.

ACS

Qu, L.; Liu, B.; Zhang, H.; Sankey, E.W.; Chai, W.; Wang, B.; Li, Z.; Niu, J.; Zhao, B.; Jiang, X.; Ye, L.; Zhao, L.; Zhang, Y.; Zheng, T.; Xue, Y.; Chen, L.; Chen, L.; Han, H.; Liu, W.; Li, R.; Gao, G.; Wang, X.; Wang, Y.; He, S. Management of Postoperative Pain after Elective Craniotomy: A Prospective Randomized Controlled Trial of a Neurosurgical Enhanced Recovery after Surgery (ERAS) Program. Int. J. Med. Sci. 2020, 17 (11), 1541-1549. DOI: 10.7150/ijms.46403.

NLM

CSE

Qu L, Liu B, Zhang H, Sankey EW, Chai W, Wang B, Li Z, Niu J, Zhao B, Jiang X, Ye L, Zhao L, Zhang Y, Zheng T, Xue Y, Chen L, Chen L, Han H, Liu W, Li R, Gao G, Wang X, Wang Y, He S. 2020. Management of Postoperative Pain after Elective Craniotomy: A Prospective Randomized Controlled Trial of a Neurosurgical Enhanced Recovery after Surgery (ERAS) Program. Int J Med Sci. 17(11):1541-1549.

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