Can ERAS principles be effective for pediatric surgery recovery?
For more than 20 years, enhanced recovery after surgery (ERAS) principles have been successfully applied in the medical care of adults. However, despite significant success in optimizing organ function, reducing the psychological stress of surgery and providing effective pain control, ERAS principles have not been widely adopted in pediatric care.
“A team of surgeons here at Children’s Healthcare of Atlanta identified an opportunity to implement a modified ERAS protocol in pediatric patients who are undergoing cleft palate repair,” explains Joseph K. Williams, MD, Chief of Plastic Surgery at Children’s Healthcare of Atlanta at Scottish Rite hospital and Director of Research at the Center for Craniofacial Disorders at Children's. “Similar to how ERAS has benefited adult patients, we hope this will accelerate post-operative recovery and optimize pain control, while also limiting narcotic use for our pediatric patients.”
Dr. Williams worked with Colin M. Brady, MD, and Magdalena Soldanska, MD, both pediatric plastic surgeons at Children’s, as well as Stefanie Hush, MMSc, PA-C, a Pediatric Nurse at Children’s, on research related to ERAS protocols, specifically focused on pediatric craniofacial surgery.
The ERAS protocol adopted for patients who underwent cleft palate repair at Children’s focused on three phases of surgical care, including pre-, intra- and post-operative phases.
What are key components of the ERAS protocol at Children's?
- Pre-operative patient education
- Reduction of pre-operative fasting intervals
- Use of minimally invasive surgical techniques when feasible
- Multimodal analgesia
- Regional anesthesia
- Early mobilization to enhance return to premorbid conditioning
“Effective implementation of these six principles required the support of a multidisciplinary team of plastic surgeons, anesthesiologists and perioperative nurses. This initiative is successful because of the commitment of Children’s to advance the care of our pediatric patients, as well as support within our team for this nontraditional method of pain management,” says Dr. Williams.
The ERAS protocol was piloted among cleft palate patients at Children’s from April 2017 to June 2018. During that time, significant outcomes improvements were observed in the pilot group when compared with a retrospective analysis of the control group.