Today I wanted to discuss recovery after surgery as it is frequently the difference in having a positive or a negative surgical experience. I am asked daily what to expect after surgery and particularly how bad is it going to hurt. Surgery is scary enough and with the prospect of poorly controlled pain or bad nausea and vomiting who would ever have surgery.
So what is Enhanced Recovery after Surgery (ERAS)? Why should I be interested in this?
So ERAS has many forms depending on surgical specialty but the main goals have always been safer, cheaper, and more effective recoveries after surgery. It has been used by multiple surgical specialties such as general, colorectal, bariatric, neurologic, orthopedic, and gynecologic surgery. Recently multiple studies have been published about incorporating ERAS into plastic surgery procedures. Almost every study published has shown benefits of decreasing patient discomfort, decreasing hospital days, and cost savings.
I review the ERAS literature routinely and adapt new findings with strong evidence to my practice. Currently I am using a modification of the ERAS protocol published by the Vanderbilt plastic surgery group published for breast reconstruction for our patients undergoing procedures under general anesthesia.
The goals of using ERAS for our patients are:
1.) Decrease pain by blocking multiple pathways of pain before, during, and after surgery.
Before surgery we administer acetaminophen (Tylenol), celecoxib (Celebrex), and Neurontin (gabapentin). Before making any incisions I always will perform local anesthetic blocks using a combination of xylocaine (Lidocaine) and bupivacaine (Marcaine) which will block the painful signal from ever being transmitted to the brain once I begin actually making incisions. During the surgery the anesthesiologist will be using other medications such as Propofol, ketamine, and ketorolac with the idea to minimize opioid use during surgery. After surgery we continue with our preoperative medication to continue blocking pain receptors via multiple pathways and add an opioid for breakthrough pain.
2.) Decrease risks of constipation and nausea and vomiting
By minimizing our narcotic use we can ideally avoid gastrointestinal distress such as constipation of nausea and vomiting. We also prescribe a stool softer and aggressively use antiemetics such as Zofran and Phenergan.
3.) Decrease risks of blood clots (venous thromboembolism or DVT)
Sequential compression devices are placed and running before the start of anesthesia. This allows for continued release of factors that keep the blood thin while you are under anesthesia and helps minimize the chance of any blood clot forming. For patients undergoing longer body contouring cases such as lipoabdominoplasty, body lifts, or high volume liposuction I routinely prescribe 1 week of Enoxaparin (Lovenox) to prevent DVT.
If you are researching a breast augmentation, breast lift, tummy tuck, liposuction, or facelift in the central Texas region including Austin, Round Rock, Cedar Park, Manor, San Marcos, Pflugerville make sure to ask your surgeon if they are using ERAS or come and see us so we can go into details about how it might help you recover safer and faster after your procedure.