ERAS: Pre- and Post-Operative Consideration in Lumbar Spine Surgery

Enhanced recovery after surgery (ERAS) enables improvement and standardization of perioperative care, thus aiming to reduce postoperative complications, stress response to surgery, and detrimental effects on cardiorespiratory functions. ERAS increases patient satisfaction, facilitates early resumption of normal activities and decreases hospital stay. Lumbar and cervical spine surgeries (microdiscectomy, fusion) and correction of scoliosis are commonly performed but in some cases patients have a relatively long recovery time, necessitating the formulation of protocols for early recovery. ERAS protocols focus on three main pillars: evidence-based perioperative protocols, multidisciplinary teamwork, and continuous monitoring. Standardized, evidence-based protocols for lumbar fusion surgeries have been formulated and published. Preoperative interventions include medical optimization of comorbidities, nutritional optimization, preoperative counseling, preoperative carbohydrate loading, and PONV prophylaxis. Intraoperative interventions include minimally invasive surgeries, avoidance of drains and tubes, regional anesthesia, opioid-free anesthesia, restrictive fluid management, temperature control, adequate pain management, early removal of surgical tubes and drains, early return to parenteral nutrition, opioid-sparing pain control, early mobilization, and follow-up. These protocols aim to reduce complications, reduce hospital stays, and promote early return to daily physical activity. However, there is a lack of specific guidelines for applying ERAS protocols in patients belonging to extreme age group, i.e., pediatric and geriatric. Further research is needed to determine the effectiveness of these protocols in complex spinal fusion surgeries especially in patients with comorbid conditions.