Enhanced recovery after surgery (ERAS) pathways have portrayed practical and safe in elective spinal procedures. In this study, for patients undertaking elective spine and peripheral nerve surgery, a substantial improvement, along with extensive compliance, for those who joined in the ERAS protocol was established. 

Given the limited number of studies concerning ERAS pathways in elective neurosurgery, this study aimed to explore its usage in elective spinal surgery during one and a half year.

Overall, 1,141 patients were prospectively registered in an ERAS protocol and historical cohort of 149 consecutive patients was recognized as the control group. The prerequisite for opioid use 1 month after the operation was the primary outcome. Opioid and non-opioid ingestion on postoperative day (POD) 1, opioid use at 3 and 6 months after the operation, inpatient pain scores, patient satisfaction scores, postoperative Foley catheter usage, mobilization/ambulation on POD 0–1, duration of stay, concerning issues, and admissions to the intensive care unit (ICU).

Patients were supplemented with printed information on ERAS and surgical site maintenance (Figure 1).

Figure 1: ERAS Pathway

A significant decrease in opioids consumption at 1, 3, and 6 months after operation (38.6% versus 70.5%, 36.5% versus 70.9%, and 23.6% versus 51.9%) was observed. Similar surgical procedures and demographics were prevalent in both groups. 

In the ERAS group, use of patient-controlled analgesia i.e. PCA almost eliminated (1.4% versus 61.6%), figure 2:

ERAS patients mobilized quicker on POD 0 than control (63.5% versus 20.7%), Figure 3: 

Fewer patients in the ERAS group needed postoperative catheterization (40.7% versus 32.7%). The ERAS group also had reduced duration of stay (3.4 versus 3.9 days).

For all elective spine and peripheral nerve techniques, ERAS protocols were found to be promising and effective as it lessens opioid usage, eliminates PCAs use, mobilizes patients faster, and decreases the duration of stay.