Although enhanced recovery after surgery (ERAS) protocols have been widely applied during perioperative periods for different diseases, there are few reports of ERAS in patients undergoing endoscopic sinus surgery (ESS). This study therefore aimed to evaluate the benefits of ERAS protocol compared to traditional care following ESS.
Methods
A total of 55 patients with chronic rhinosinusitis undergoing ESS were prospectively assigned to 1 of 5 treatment groups; ERAS groups with postoperative intravenous Flubiprofen Axetil or analgesia pump, traditional care with Flubiprofen Axetil or analgesia pump (NERAS groups), or traditional care without postoperative intravenous analgesia group (control). All patients completed the Kolcaba General Comfort Questionnaire, Medical Outcomes Study Sleep Scale, and Self-rating Anxiety Scale at admission and before discharge. Pain scores were recorded at 2, 6, 24, and 48 hours postsurgery and adverse reactions to analgesics were noted.
Results
Patients in ERAS group demonstrated significantly higher general comfort scores and lower self-rating anxiety scores compared to patients in NERAS and control groups. Compared to control patients, patients in ERAS group reported significantly lower pain scores at 6, 24, and 48 hours. Moreover, pain alleviated from 6 hours postsurgery in ERAS group compared to 48 hours in NERAS group. Patients using opioids experienced more adverse nausea events than patients using only nonsteroidal anti-inflammatory drugs (NSAIDs).
Conclusions
The use of patient-tailored ERAS programs following ESS may help to attain higher general comfort and to alleviate perioperative anxiety compared with traditional perioperative care. Adequate postoperative analgesia with NSAIDs in ERAS protocol may alleviate pain earlier with fewer adverse reactions.
Dietz de LoosDLourijsenESWildemanMAM, et al.
Prevalence of chronic rhinosinusitis in the general population based on sinus radiology and symptomatology.J Allergy Clin Immunol. 2019;
143:1207–1214.
2.
FokkensWJLundVJMullolJ, et al.
EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists.Rhinology. 2012;
50:1–12.
3.
TomoumMOKlattcromwellCDelSignoreAEbertCSeniorBA.Depression and anxiety in chronic rhinosinusitis.Int Forum Allergy Rhinol. 2015;
5:674–681.
4.
SchlosserRJHyerJMSmithTL, et al.
Depression-specific outcomes after treatment of chronic rhinosinusitis.JAMA Otolaryngol Head Neck Surg. 2016;
142:370–376.
5.
XiaoYHanDZangHWangD.The effectiveness of nasal surgery on psychological symptoms in patients with obstructive sleep apnea and nasal obstruction.Acta Otolaryngologica. 2016;
136:626–632.
6.
LiHZhangXSongYWangTTanG.Effects of functional endoscopic sinus surgery on chronic rhinosinusitis resistant to medication.J Laryngol Otol. 2014;
128:976–980.
7.
AdamsKNSchumanTAEbertCSYouWTomoumMOSeniorBA.Self-reported anxiety and depression unchanged after endoscopic sinus surgery for chronic rhinosinusitis.Rhinology. 2018;
56:234–240.
8.
SlimK.The benefits of enhanced recovery after surgery.J Viscer Surg. 2016;
153:S41–S44.
9.
KehletH.Multimodal approach to control postoperative pathophysiology and rehabilitation.Br J Anaesth. 1997;
78:606–617.
10.
BenbouzidATabchouriNDenetC, et al.
Enhanced recovery protocols in colonic surgery: retrospective cohort analysis of economic impact from an institutional point of view.Int J Colorect Dis. 2019;
34:301–307.
11.
Merki-KunzliCKerstan-HuberMSwitallaD, et al.
Assessing the value of prehabilitation in patients undergoing colorectal surgery according to the enhanced recovery after surgery (ERAS) pathway for the improvement of postoperative outcomes: protocol for a randomized controlled trial.JMIR Res Protoc. 2017;
6:e199.
12.
BatchelorTJPRasburnNJAbdelnour-BerchtoldE, et al.
Guidelines for enhanced recovery after lung surgery: recommendations of the enhanced recovery after surgery (ERAS(R)) Society and the European Society of Thoracic Surgeons (ESTS).Eur J Cardiothorac Surg. 2019;
55:91–115.
13.
MelloulEHubnerMScottM, et al.
Guidelines for perioperative care for liver surgery: enhanced recovery after surgery (ERAS) society recommendations.World J Surg. 2016;
40:2425–2440.
14.
LiMZWuWHLiL, et al.
Is ERAS effective and safe in laparoscopic gastrectomy for gastric carcinoma? A meta-analysis.World J Surg Oncol. 2018;
16:17.
15.
LiLChenJLiuZLiQShiY.Enhanced recovery program versus traditional care after hepatectomy: a meta-analysis.Medicine. 2017;
96:e8052.
16.
ZhuSQianWJiangCYeCChenX.Enhanced recovery after surgery for hip and knee arthroplasty: a systematic review and meta-analysis.Postgrad Med J. 2017;
93:736–742.
17.
ForsmoHMErichsenCRasdalATvinnereimJMKörnerHPfefferF.Randomized controlled trial of extended perioperative counseling in enhanced recovery after colorectal surgery.Dis Colon Rectum. 2018;
61:724–732.
18.
PędziwiatrMKisialeuskiMWierdakM, et al.
Early implementation of enhanced recovery after surgery (ERAS®) protocol—compliance improves outcomes: a prospective cohort study.Int J Surg. 2015;
21:75–81.
19.
WuXFKongWFWangWH, et al.
Enhanced recovery after surgery protocols in functional endoscopic sinus surgery for patients with chronic rhinosinusitis with nasal polyps: a randomized clinical trial.Chin Med J. 2019;
132:253–258.
20.
WuXKongWZhuQ, et al.
Improved perioperative quality of life in endoscopic sinus surgery by application of enhanced recovery after surgery.Therap Clin Risk Manag. 2019;
15:683–688.
21.
Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures: An Updated Report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration.Anesthesiology. 2017;
126:376–393.
22.
LundVJKennedyDW.Quantification for staging sinusitis. The Staging and Therapy Group.Ann Otol Rhinol Laryngol Suppl. 1995;
167:17–21.
23.
KolcabaKY.Holistic comfort: operationalizing the construct as a nurse-sensitive outcome.ANS Adv Nurs Sci. 1992;
15:1–10.
24.
HaysRDMartinSASestiAMSpritzerKL.Psychometric properties of the Medical Outcomes Study Sleep measure.Sleep Med. 2005;
6:41–44.
25.
ZungWW.A rating instrument for anxiety disorders.Psychosomatics. 1971;
12:371–379.
26.
LjungqvistOScottMFearonKC.Enhanced recovery after surgery: a review.JAMA Surg. 2017;
152:292–298.
27.
BeverlyAKayeADLjungqvistOUrmanRD.Essential elements of multimodal analgesia in enhanced recovery after surgery (ERAS) guidelines.Anesthesiol Clin. 2017;
35:e115–e143.
28.
KehletHWilmoreDW.Multimodal strategies to improve surgical outcome.Am J Surg. 2002;
183:630–641.
29.
KumarLKumarAHGrantSAGadsdenJ.Updates in enhanced recovery pathways for total knee arthroplasty.Anesthesiol Clin. 2018;
36:375–386.
30.
SaidianANixJW.Enhanced recovery after surgery: urology.Surg Clin N Am. 2018;
98:1265–1274.
31.
SmithHJLeathCAIIIStraughnJMJr.Enhanced recovery after surgery in surgical specialties: gynecologic oncology.Surg Clin N Am. 2018;
98:1275–1285.
32.
LiaoZLiaoWTanKS, et al.
Decreased hospital charges and postoperative pain in septoplasty by application of enhanced recovery after surgery.Therap Clin Risk Manag. 2018;
14:1871–1877.
33.
CarmichaelJCKellerDSBaldiniG, et al.
Clinical practice guideline for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons (ASCRS) and Society of American Gastrointestinal and Endoscopic Surgeons (SAGES).Surg Endosc. 2017;
31:3412–3436.
34.
NakaiKNiwaHKitayamaMSatohYHirotaK.Effects of oral rehydration therapy on gastric volume and pH in patients with preanesthetic H2 antagonist.J Anesth. 2012;
26:936–938.
35.
LjungqvistONygrenJThorellA.Modulation of post-operative insulin resistance by pre-operative carbohydrate loading.Proc Nutr Soc. 2002;
61:329–336.
36.
Arsalani‐Zadeh R, ElFadl D, Yassin N, MacFieJ.Evidence-based review of enhancing postoperative recovery after breast surgery.Br J Surg. 2011;
98:181–196.
37.
WiseSKWiseJCDelGaudioJM.Evaluation of postoperative pain after sinonasal surgery.Am J Rhinol. 2005;
19:471–477.
38.
GrayMLFanCJKappaufC, et al.
Postoperative pain management after sinus surgery: a survey of the American Rhinologic Society.Int Forum Allergy Rhinol. 2018;
8:1199–1203.
39.
TanMLawLSGanTJ.Optimizing pain management to facilitate enhanced recovery after surgery pathways.Can J Anaesth. 2015;
62:203–218.
40.
BeckerSDBeckerDG.Review and update on postoperative opioid use after nasal and sinus surgery.Curr Opin Otolaryngol Head Neck Surg. 2018;
26:41–45.
41.
NimmoSMFooITHPatersonHM.Enhanced recovery after surgery: pain management.J Surg Oncol. 2017;
116:583–591.
42.
KehletHDahlJB.The value of “multimodal” or “balanced analgesia” in postoperative pain treatment.Anesth Analg. 1993;
77:1048–1056.
43.
KumarADasSChauhanSKiranUSatapathyS.Perioperative anxiety and stress in children undergoing congenital cardiac surgery and their parents: effect of brief intervention—a randomized control trial.J Cardiothorac Vasc Anesth. 2019;
33:1244–1250.
