Enhanced recovery after surgery decreases pain in thoracic surgery

Abstract

Objectives: Enhanced recovery after surgery (ERAS) is the application of simple measures in the postoperative care with the aim of reducing morbidity and mortality, and accelerating rehabilitation and hospital discharge. The evidence of ERAS benefits in thoracic surgery remains limited due to the selectivity of the type of surgical resection and thoracic pathology in published studies. This study was designed to evaluate the effectiveness of postoperative care using the ERAS protocol compared to traditional one in thoracic surgery.

Materiel and Methods: This is a prospective randomized controlled study, conducted between December 2015 and August 2017 at the department of Thoracic and Cardiovascular Surgery of the Habib Bourguiba University Hospital in Sfax, Tunisia.

Results: One hundred patients undergoing thoracic surgery were randomly allocated to ERAS group or control group. The following complication rates were lower in the ERAS group: Lack of re-expansion (14.63% vs 16.10%: p=0.72), pleural effusion (0% vs 10.86%, p=0.05) and prolonged air leak (17.07% vs 30.43%, p=0.14). The level of pain decreased significantly in the ERAS group from postoperative H3 (p=0.006). This difference was significant at H6 (p=0.001), H24 (p=0.05), H48 (p=0.01), discharge (p=0.002) and after 15 days (p=0.01) with a decreased analgesic consumption. The length of hospital stay was shorter in the ERAS group (median 6 days vs 7 days, p= 0.17).

Conclusion: The ERAS protocol can reduce post operative pain. This study provides an ERAS protocol, applicable to any thoracic surgery pathology, approach or type of resection.