Background & Aims
The implementation of ERAS has faced many hurdles worldwide. Studies have shown low compliance rates of adherence to ERAS protocols . Differences also exist between various protocols, some being easier to implement than others. For example, protocols that were already part of routine practice such as prophylactic antibiotics, thromboprophylaxis and minimally invasive techniques were easier to implement than practices such as no bowel preparation, early catheter removal, no opioids and restrictive fluid therapy. Studies have shown repeatedly that compliance with postoperative ERAS protocols have significantly influenced outcomes although greater success of protocols with more elements has not been demonstrated over protocols with fewer elements .
Given the above barriers and findings, the idea of a flexible and individualised protocol has been floated rather than a rigid protocol which might affect compliance and thereby, outcomes.
Methods
With in a year, all those patients who underwent elective general surgical procedures under ERAS program; their data was retrospectively analysed for the length of hospital stay and for post operative complications. The common modalities used were also analysed and presented in results as frequency.
Results
In one year a total of 52 cases were done according to the ERAS program. 13 patients were male and 39 female. A total of 42 patients had laparoscopic cholecystectomy, 2 hernia repair, 4 patients under went open colectomy, 4 open anterior resection. In premedication, 40 patients received gabapentin, 39 celecoxib and 39 carbohydrate drink 200 ml.
Intra-operatively, nalbuphine was given to 44 patients, 4 patients received tramadol, 4 patients received morphine, paracetamol was given to 36 patients and 13 patients received ketorolac. Tranversus abdominis plane block was performed in 8 patients and rectus sheath block in 4 patients. Local anesthetic infiltration was done in 18 patients. Out of 8 major open abdominal surgeries, 6 patients received epidural analgesia. 36 (81.8 %) patients who had laparoscopic surgery discharge to home with in 24 hour. In open colorectal surgery, only 3 patients had length of stay less than 3 days where as 5 patients has length of stay more than 3 days.
Conclusions
Specially in LMICs we can save resources by implementing ERAS program. It will not only improves the operating room efficiency but also reduce the ward bed occupancy. In this study we found ERAS program very successful in laparoscopic procedures but in open colorectal procedures, it could not turned out to be successful. One major cause was post operative pain which could improve by learning and applying new modalities for pain management, that should be economically sustainable and by modifying surgical techniques as well, either by getting expertise in laparoscopic procedure or by using transverse incision.
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