Improving anesthesia, surgery by expanding ERAS protocols
January 17, 2024
For many patients, being “put under” is one of the most nerve-wracking aspects of surgery. And yet, anesthesia is often an afterthought.
Details of the anesthesia plan are not typically discussed in depth prior to the procedure, and many patients don’t even meet their anesthesiologist until they are getting prepped for surgery. That’s when they have a lot of questions, such as:
What are you going to use to sedate me? Is it safe? Will I be able to hear or feel anything during surgery? How much pain should I expect? I’ve had nausea before…how would you treat that?
At UT Southwestern, we are working to transform the surgical and anesthesia experience by empowering patients through a program called Enhanced Recovery After Surgery (ERAS).
Our ERAS protocols are evidence-based approaches to care before, during, and after surgery. They are designed by surgeons, anesthesiologists, nurses, advanced practice providers, and therapists who have expertise in the care of surgical patients who are undergoing complex procedures. ERAS improves surgical outcomes and benefits patients in many ways, including:
- Shorter hospital stays
- Fewer complications, including readmission
- Better pain control
- Faster recoveries
- Lower health care costs
- Improved patient satisfaction
We have ERAS protocols in place for 18 types of surgery, and more on the way. We also prioritize anesthesia education at our specialized Presurgical Testing Clinic, where patients will learn what to expect and get a chance to meet with a member of our anesthesiology team.
The results are often better outcomes for patients, a more personalized pain management experience, and faster return to everyday activities.
What is ERAS, really?
Think of ERAS as a game plan for your surgical experience, led by your surgeon and anesthesiologist. It provides a structured baseline for each step of the procedure, keeping your entire care team on the same page while allowing customizations for your specific needs, such as chronic conditions and personal preferences.
In an ERAS-guided procedure, the provider team will explain everything that will happen before, during, and after surgery.
Before surgery
- Instructions for medications, food, and drinks you can and can’t have in the hours before surgery.
- Suggestions for lifestyle modifications to optimize your health before surgery, such as quitting smoking or changing exercise habits.
- Expectations, such as when you can start eating again, activities after surgery, pain control. We will let you know when you should leave the hospital. Many patients challenge themselves to get out sooner, if it’s safe to do so.
During surgery
- How long you are expected to be sedated and how we’ll monitor you during surgery.
- The type of anesthesia you are going to get and how that will help decrease the stress on your body and improve your overall outcome.
- The plan for pain control, such as nerve blocks and non-narcotic medications.
After surgery
- The plan for medications to control potential pain or nausea.
- How soon we will help you get up and moving.
- Food and drink you can and should consume.
Related reading: Frequently asked questions about ERAS
The impact of ERAS
UTSW’s ERAS protocols have proven effective in many specialties. Here are just a few examples:
Gynecology: Patients average two fewer days in the hospital after open hysterectomy. About 90% of patients who have a non-cancer-related hysterectomy go home the same day (up from 50% pre-ERAS), and infection rates have been cut in half.
Breast reconstruction pathway: Patients recover in a regular room instead of the intensive care unit, shortening their stay, encouraging rest at night, and reducing the amount of pain medication needed after surgery.
Colorectal surgery infection rates have decreased by half.
Presurgical Testing Clinic
Depending on your surgery, we may invite you to visit our Presurgical Testing Clinic. Here, you will meet with an anesthesiologist, nurse anesthetist, or physician’s assistant to discuss how we’ll approach your sedation and pain management with regard to specific conditions, such as diabetes, high blood pressure, or obesity.
For example, patients traditionally have been asked to fast (no eating or drinking) after midnight on the day of their surgery – even if surgery is 12 hours later. That’s not ideal for anyone, particularly for patients with blood sugar concerns. ERAS protocols still ask you to refrain from eating after 11 p.m., but often we can allow you to drink clear fluids such as water, Gatorade, Sprite, or even black coffee with no cream or sugar up to two hours prior to surgery. Research shows this can help patients feel more comfortable, remain more hydrated, and return to normal bowel function sooner after surgery.
ERAS also promotes the use of multimodal pain relief to reduce opioid use when appropriate. We typically recommend a combination of non-opioid medications to help control your pain including Tylenol, muscle relaxants and non-steroidal anti-inflammatory medications (NSAIDs) such as ibuprofen. This includes taking some medications before surgery to start blocking receptors that allow you to feel pain, which can help make recovery more comfortable.
In the presurgical appointment, we’ll also talk about how your past surgery experiences might inform your future care plan. If your health needs or preferences don’t fit all the ERAS recommendations, we can find other effective strategies. For example, if you had a bad reaction to a medication in the past and it’s in our plan, we’ll look for an alternative for your surgery.
A few final thoughts about ERAS
ERAS programs are becoming the gold standard of surgical care, streamlining your experience from beginning to end and helping you recover sooner. Just as importantly, ERAS gives you more ownership of your surgery and recovery.
We make sure that you get all the information you need about your condition and treatment plan in advance, and our team of experts will help make your surgery and recovery the best they can be.
To learn about ERAS protocols for a specific surgery, call 214-645-8300 or request an appointment online.
