Improved analgesia and reduced post-operative nausea and vomiting after implementation of an enhanced recovery after surgery (ERAS) pathway for total mastectomy

• DOI: 10.1186/s12871-018-0505-9
• Publication Date: 2018-04-16T12:44:30Z
• Authors: Catherine Chiu; Pedram Aleshi; Laura J. Esserman; Christina Inglis-...; Edward Yap; Elizabeth L. Whit...; Monica W. Harbell
• Keywords: Pain medicine

Enhanced Recovery After Surgery (ERAS) pathways have been shown in multiple surgical disciplines to improve outcomes, including reduced opioid consumption, length of stay, and post-operative nausea vomiting (PONV). However, very few studies describe the application ERAS breast surgery even fewer for outpatient surgery. We implementation efficacy an pathway total skin-sparing mastectomy with immediate reconstruction setting. implemented evidence-based, multimodal all patients undergoing at a single 23-h stay center. Highlights included: preoperative acetaminophen, gabapentin, scopolamine; regional anesthesia (Pectoral blocks type 1 2 or paravertebral block); intraoperative dexamethasone ondansetron. This retrospective study included American Society Anesthesiology (ASA) Class 1–3 between July 2013 April 2016. compared 96 who were (ERAS group) cohort 276 (Pre group). The primary outcome was perioperative consumption. Secondary outcomes highest postoperative pain scores, incidence PONV, stay. Patients group had significantly lower consumption Pre (mean (SD): 111.4 mg (46.0) vs. 163.8 (73.2) oral morphine equivalents, p < 0.001). also PONV (28% 50%, reported less recovery room, two-point decrease score (median [interquartile range (IQR)]: 4 [2,6] 6 [4,7] group, There no clinically significant difference [IQR]: 1144 min [992, 1259] 1188 [1058, 1344] = 0.006). Implementation that incorporates is feasible 23-h-stay hospital. improved analgesia vomiting.