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Edition 3 - enhanced recovery after surgery

The aim of this research roundup is to provide vet professionals with an easy-to-read digest on three items of research in pain management which focus on one common subject area.

This research roundups provide a single point of reference for the reader.


Subject

Enhanced recovery after surgery (ERAS)


Title of the paper

Recommendations from the ERAS® Society for standards for the development of enhanced recovery after surgery guidelines

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6996628/pdf/BJS5-4-157.pdf


Aim of the paper

To ensure a standard approach is taken to the development of ERAS guidelines, by setting out clearly what such an approach looks like.


Review of methodology

The paper is a clear set of guidelines which can be used to create procedure-specific guidelines.

Key points to aid reflection

The authors clearly state that the ERAS approach has shown that early mobilisation, nutrition and rapid discharge post-surgery are all feasible and beneficial to patients.

At Zero Pain Philosophy we believe that analgesia forms a key component of ERAS. ERAS is specific to an individual procedure and therefore also specific to the individual practice set up. Consider which procedures conducted in your practice can be reviewed within the ERAS principles. The guidelines on how to do this (page 158 onwards) can be modified for the veterinary practice. There is also the opportunity to involve the pet owner in this work.

An example of a topic would be optimising analgesia for neutering. We have two resources on this topic that can help you formulate your own ERAS protocol

Webinar – nerve blocks for neutering


Pain Update – intraperitoneal and incisional analgesia


These two resources help answer question in step 4 (p160) – analysing the quality of evidence has already been done here by the authors of the BSAVA capsule review.


Our assessment of the paper

We see the concept of ERAS as a potential gamechanger for how we manage cases in veterinary practice. How many times do you hear differences in opinion on how to manage routine cases? How simple to everyone and beneficial to the patient could this be if we took some time to create an agreed approach using ERAS principles?


In this section you will find our ‘everyone should read this’ recommendation and a review that we have chosen to support your next steps in integrating this with your clinical practice.


Everyone should read this

Surgical Stress: The Role of Pain and Analgesia - link


This seminal work offers us an understanding of the role of the stress response, making us ask why we should give focus to the topic. Of particular interest is the publication date of this work and how long it has taken veterinary medicine to catch up with these concepts.


Recommended review article

Enhanced Recovery After Surgery: The need for a procedure-specific approach


Where do we see the value in this work?

In our Pain Update we consider some of the literature that we have in the veterinary field that we can use to answer questions related to how we optimise recovery after surgery.


Reflections

Which procedure do you think could be examined with the ERAS guidelines?

  • Do we understand how comfortable a bitch spay is overnight after surgery?

  • Can we optimise analgesia to ensure cats eat after dental extractions?

  • Which local anaesthetic technique is best for stifle surgery?

What are the unanswered questions that you need further help with? Please contact us with these questions. If you are working on an ERAS approach in your practice, please let us know if you need help.



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