Key result
The neurosurgical ERAS protocol significantly reduced postoperative pain scores on postoperative day 1 compared to conventional care (mean NRS 3.12 vs. 4.44, OR 0.0968, p=0.010) in patients undergoing elective craniotomies.
Why the study?
The efficacy of a neurosurgical enhanced recovery after surgery (ERAS) protocol for managing postoperative pain after elective craniotomies had not been prospectively evaluated.
Does the neurosurgical ERAS protocol reduce postoperative pain in patients undergoing elective craniotomies?
RCT (n=129)
Single-blind (outcome assessors only)
Simple randomization procedures (computerized random numbers)
No
Does the neurosurgical ERAS protocol reduce postoperative pain in patients undergoing elective craniotomies?
Odds Ratio: 0.0968 (95% CI 0.3299–2.317)
Absolute Event Rate: 3.12% vs 4.44%
p-value: p=0.010
Implementation of a neurosurgical ERAS protocol significantly reduces postoperative pain and length of hospital stay in patients undergoing elective craniotomies.
ERAS reduces early pain after elective craniotomy; supports adoption and extends ERAS evidence to neurosurgery.
Objective: To prospectively evaluate the efficacy of neurosurgical enhanced recovery after surgery (ERAS) protocol on the management of postoperative pain after elective craniotomies. Methods: This randomised 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 ERAS protocol and conventional care. 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 postoperative pain score on POD 1 compared to patients in the control group (mean NRS 3.12 vs. 4.44, OR 0.0968, 95% CI 0.3299 to 2.317, p = 0.010). 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 significant reduction in pain score was observed on POD 2 and POD 3 in the ERAS group compared with that in the control group (POD2: mean NRS 2.85 vs. 4.32, OR 0.2628, 95% CI 0.5619 to 2.379, p=0.002. POD3: mean NRS 2.32 vs. 4.03, OR 0.1468, 95% CI 0.9537 to 2.458, p < 0.001, respectively). In addition, the median postoperative length of hospital stay was significantly decreased with the incorporation of ERAS protocol compared to the controls (ERAS: 4 days, control: 7 days, P<0.001). Conclusion: Implementation of the neurosurgical ERAS protocol for elective craniotomy patients have significant benefits in alleviating postoperative pain and enhancing recovery after surgery compared to the conventional care. Further evaluation of this protocol in larger, multi-center studies is warranted.
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Qu et al. (2020) conducted an RCT in Elective craniotomy (n=129). Neurosurgical enhanced recovery after surgery (ERAS) protocol vs. Conventional care protocol was evaluated on Postoperative pain score assessed by a verbal numerical rating scale (NRS) on postoperative day 1 (OR 0.0968, 95% CI 0.3299-2.317, p=0.010). The neurosurgical ERAS protocol significantly reduced postoperative pain scores on postoperative day 1 compared to conventional care (mean NRS 3.12 vs. 4.44, OR 0.0968, p=0.010) in patients undergoing elective craniotomies.
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