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Enter a New Era in Spine Surgery With Enhanced Recovery After Surgery (ERAS)

Authored by Dr. Ehsan Jazini. September 15, 2020

In a fast-paced world where every moment counts, a faster surgery recovery time is becoming necessary. Post-surgery, many patients are itching to get back to their lives without pain and medication, and with this, in mind, we are on the forefront developing a 21st-century patient-centered approach to the comprehensive spine surgery experience. These stages include pre-hospital, preoperative, intraoperative (during surgery), and postoperative, and the return home. 

The Enhanced Recovery After Surgery (ERAS®) is a series of evidence-based care pathways helping evolve spine surgery recovery, including better pain control, eliminating the need for IV pain medications, and reducing opioids. These advancements allow your medical team to use the best data-driven practices to help patients mobilize after surgery, shorten hospital stays, and recover faster. 

After conducting extensive research, we presented our research outcomes at the North American Spine Society (NASS) international meeting of spine surgeons from around the world. Our findings proved that with ERAS protocols implemented, we were able to reduce the number of painkillers (including pain pump) given to patients in the hospital as well as reduce hospital stays. Patients also were up on their feet and walking sooner, mobilizing their recovery right in the hospital. 

What is Enhanced Recovery After Surgery (ERAS)?

ERAS® is an innovative set of protocols designed to help educate patients, prepare them for surgery, and allow them to have a speedy recovery from spine surgery so that they can resume their life activities expeditiously. We at the Virginia Spine Institute, in collaboration with Reston Hospital Center, have developed a tailored program for patients undergoing spine surgery. Preparing for and undergoing spine surgery is analogous to training, completing, and recovering from a marathon. Preparing, or training, for a marathon, a runner must undergo dedicated fitness training, nutrition program, and mental preparedness prior to a successful completion of a run. ERAS® is meant to be a similar “training program” that is used before, during, and after spine surgery. This comprehensive approach, looking at the complete surgical picture, aids in effectively and efficiently taking the patient through

Before undergoing spine surgery, preparation must be done to ensure that the patient’s body is properly prepared – for example, proper nutrition and avoiding detrimental habits such as smoking or excessive drinking. As part of this preparation, educating patients on their expectations regarding the surgery and their recovery is critical. On the morning of the surgery, the patient is proactively given a cocktail of medications that help support the nerve and muscle function, minimizing the need of pain medications. In conjunction with our anesthesiologists, we also use local anesthetics to help reduce the need for pain medications during surgery, as well as after surgery. 

After surgery, In the recovery unit, patients are mobilized within two hours of surgery in order to start the function of their muscles and joints, which has been shown to help reduce the need for pain medications post-surgery. The patients are then placed on both long- and short-acting pain medications to help avoid the acute crisis of uncontrolled pain, reducing the risk of delayed recovery. Using this regimen, we have been able to avoid the use of Patient Controlled Analgesic (PCA) pumps, often referred to as “pain pumps”, which were found to be ineffective in controlling post-surgical pain control, even requiring more pain medications to be used when compared to the ERAS® protocol.

What are the Benefits of Enhanced Recovery After Surgery (ERAS®)? 

So what does all of this mean for our patients? Essentially we are providing patients with safer, faster, and more efficient recovery post-surgery. ERAS® presents a healthier and safer way to perform surgery for our patients with less medications needed for pain management. The combination of treatment before, during, and after is what makes ERAS® innovative and effective.

The Virginia Spine Institute, in collaboration with the National Spine Health Foundation, has made great strides in innovation and research with regards to enhancing our patients’ recovery after spine surgery. We evaluated patient outcomes, pre-ERAS, and ERAS,  as well as compared patients with smaller surgeries and complex deformity surgeries. We were able to demonstrate a significant decrease in pain medication needs and usage in patients after spine surgery, ultimately getting them up and moving faster and translated to shorten hospital stays, getting our patients back to their lives quicker! 

If you’re considering spine surgery, ask your spine surgeon about the benefits of utilizing ERAS® protocols to help you recover faster, by minimizing the impact of surgery on your body.

About The Authors

Dr. Ehsan Jazini

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