Postoperative pain management in the enhanced recovery after surgery (ERAS) for emergency laparoscopic cholecystectomy

Abstract

Introduction. Enhanced recovery after surgery (ERAS) is a new patient-centered concept that aims to deliver high-quality perioperative care to surgical patients. This study was performed to compare the effectiveness of the pain management measures in an ERAS-protocol versus the traditional approach of postoperative pain. Materials and Methods. A comparative prospective study was performed on 50 patients admitted in the Fourth General Surgery of University Emergency Hospital of Bucharest between 2022 and 2024, with the diagnosis of acute cholecystitis, undergoing emergency laparoscopic cholecystectomy. The patients were randomly assigned into two study groups, an ERAS-group and a Traditional group, according to the type of perioperative care applied. The evaluated outcomes were length-of-stay; preoperative anxiety level, leukocyte count at admission and 24 hours postoperatively, postoperative pain levels quantified using Visual Analog Scale 24 hours after surgery and postoperative nausea and vomiting events. Results. The two study subgroups were comparable in terms of demographic and clinical preoperative characteristics. Statistical analysis showed significant lower values of preoperative anxiety level in ERAS group (p<0.001), lower levels of postoperative pain (VAS 2.96±0.75 vs 4.65±1.69, p<0.001) and earlier resumption of the intestinal transit. However, there were no differences in the total hospital stay between the traditional and ERAS groups. Conclusions. Implementing ERAS protocol for emergency laparoscopic cholecystectomy improve postoperative functional outcome and the patients’ quality of care.

Keywords

• laparoscopic cholecystectomy
• emergency
• enhanced recovery after surgery (eras)
• pain management