“Enhanced recovery after surgery – ERAS in elective craniotomies-a non-randomized controlled trial”

Abstract Background Enhanced Recovery After Surgery (ERAS) is a multimodal perioperative care bundle aimed at the early recovery of patients. Well accepted in gastric and pelvic surgeries, there minimal evidence neurosurgery neurocritical barring spinal surgeries. We wished to compare length intensive unit (ICU) or high dependency (HDU) stay patients undergoing elective craniotomy for supratentorial neurosurgery: ERAS protocol versus routine care. The secondary objective was postoperative pain scores, opioid use, glycemic control, duration hospital between two groups. Methods In this pragmatic non-randomized controlled trial (CTRI/2017/07/015451), consenting adult scheduled intracranial tumor excision were enrolled prospectively after institutional ethical clearance consent. Elements-of-care group were- Preoperative –family education, complex-carbohydrate drink, flupiritine; Intraoperative – scalp blocks, limited opioids, rigorous fluid temperature regulation; Postoperative- flupiritine, mobilization, removal catheters, initiation feeds. Apart from these, all protocols management strategies similar groups compared with regards ICU stay, scores ICU, requirement, duration. decision discharge hospital, data collection, analysis by independent assessors blind patient group. Results Seventy enrolled. Baseline demographics age, sex, volume, comorbidities comparable proportion staying less than 48 h surgery, cumulative insulin episodes VAS > 4 first surgery significantly 40.6% vs. 65.7%, 0.6 (±2.5) units 3.6 (±8.1) units, one ten ( p = 0.04, 0.001, 0.004 respectively). total both Conclusion study demonstrated significant reduction requiring ICU/ HDU h. Better control period may have contributed decreased stay. More extensive randomized studies be designed confirm these results. Trial registration Clinical Registry India CTRI/2018/04/013247 ), registered retrospectively on April 2018.