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

Research Paper

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

Liang Qu1*, Bolin Liu2*, 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 Wang1✉, Shiming He2✉

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.

This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/). See http://ivyspring.com/terms for full terms and conditions.
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. Available from http://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