You are having surgery and might be nervous about how it’s all going to go. You’ll be hungry from not eating hours before and wonder how you’ll tolerate the anesthesia. When it’s all over, you expect that there will be discomfort and that your doctor will give you ‘something for the pain.’
Unfortunately, since the 1990s, when the amount of prescribed opioids began to grow, the number of overdoses and deaths from opioids also increased. Thankfully, there are now protocols put into place to help you better cope with the anesthesia and the pain and, more importantly, prevent opioid addiction.
These protocols are called ERAS, short for Enhanced Recovery After Surgery. According to the ERAS Society, by following these protocols, recovery time can be shortened by 30% or more and complication rates after the operation by at least as much. That sounds great, but when you look past the medical jargon, what does this mean to you, the patient?
“ERAS was developed as a way to get you off of opiates faster,” said Audrey Rowen, PA-C, East Cooper Plastic Surgery. “The protocol involves doing certain things before surgery, during surgery, and after. The theory behind it is that the body doesn’t handle anesthesia and pain as well when it’s been starving for eight hours.”
So taking care of you, your tolerance for anesthesia and your pain actually starts before your surgery even happens. “The night before surgery, you will take a dose of Gabapentin, which is essentially a nerve blocker medication,” said Rowen. “It can be used to treat neuropathy — numbness or weakness. You’ll get another dose the morning of surgery and then continue it while you’re in the hospital and then go home.”
ERAS protocols also include a safe, but a higher-than-normal dose of Tylenol as well as Celebrex, a nonsteroidal anti-inflammatory. “All of this helps to decrease the amount of pain you are in and the amount of prescription pain medications that you’ll need, at least for that first 24 hours,” said Rowen. “You may need the opiate prescription briefly, especially for our more major flap procedures, but we do find it’s pretty effective to take it either less often or a lower dose and get off the opiates a lot faster.”
Adjustments are made if the patient is allergic to Tylenol or Gabapentin.
And thanks to ERAS, you don’t have to go for hours without having a little something to drink. The protocol calls for patients to drink 12 ounces of Gatorade the morning of surgery. “Gatorade provides a bit of hydration and electrolytes, which helps you to handle the anesthesia a little bit better,” explains Rowen.
So the protocols focus on making you, the patient, more comfortable so your recovery goes well and, before you know it, you’re feeling better.