Enhanced Recovery After Neurosurgery

Purpose of ReviewEnhanced Recovery After Surgery (ERAS) protocols have shown significant success in improving pain scores and postoperative recovery and reducing hospital length of stay. Since the initial application in the colorectal patient population in the late 1990s, ERAS pathways have expanded to include many surgical subspecialties. This review explores the applicability of ERAS and its components in the field of cranial and spinal surgery.Recent FindingsOnly recently have researchers begun to study how to apply ERAS principles to intracranial or spine procedures. To date, robust evidence is lacking. Spine surgery patients benefit from preoperative education and early physical therapy, but how anesthetic or analgesic choice impacts recovery remains unclear. Additionally, there is a dearth of high-quality evidence to support the specific use of ERAS in cranial surgery. One randomized controlled trial, however, indicates that there is value in further study of ERAS care standardization in cranial neurosurgery and that concerns about increased complications may be unfounded. Regardless of adherence to ERAS components, the nature of intracranial surgery carries a high risk for morbidity and neurologic deficit.SummaryPatients across multiple surgical specialties benefit from ERAS protocols. Early studies suggest many of the components in these protocols can be advantageous in neurosurgery. However, how to tailor them to the neurosurgical patient is still evolving.