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Anaesthesiology Intensive Therapy
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1/2020
vol. 52
 
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abstract:
Original article

Implementation of Enhanced Recovery After Surgery (ERAS) protocol in off-pump coronary artery bypass graft surgery. A prospective cohort feasibility study

Michał Borys
1
,
Sławomir Żurek
2
,
Arkadiusz Kurowicki
2
,
Beata Horeczy
3
,
Bartłomiej Bielina
3
,
Justyna Sejboth
4
,
Bogumiła Wołoszczuk-Gębicka
3
,
Mirosław Czuczwar
1
,
Kazimierz Widenka
2

  1. Second Department of Anesthesia and Intensive Care, Medical University of Lublin, Lublin, Poland
  2. Clinical Department of Cardiac Surgery, Medical Faculty, University of Rzeszów, Rzeszów, Poland
  3. Department of Anesthesiology and Intensive Care with the Center for Acute Poisoning, St. Jadwiga Provincial Clinical Hospital, Rzeszów, Poland
  4. Department of Anaesthesia and Intensive Therapy, School of Health Sciences in Katowice, Medical University of Silesia in Katowice, Poland
Anaesthesiol Intensive Ther 2020; 52, 1: 10–14
DOI: https://doi.org/10.5114/ait.2020.93160
Online publish date: 2020/02/21
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Background
Coronary artery bypass graft (CABG) is the most commonly performed cardiac surgery procedure. Although some complications related to the cardiopulmonary bypass circuit are avoided during off-pump CABG (OP-CABG) procedures, prolonged mechanical ventilation and severe postoperative pain are still important issues.

Methods
This prospective cohort study aimed to assess the impact of the institutional Enhanced Recovery After Surgery (ERAS) protocol in patients undergoing OP-CABG. This protocol contained several modifications to the perioperative period, among which bilateral erector spinae plane block, remifentanil infusion, and patient-controlled analgesia (PCA) with oxycodone were the most important factors (ERAS group). The ERAS group was compared with the retrospective cohort (same surgeon) before the ERAS protocol was implemented (standard care group). The outcomes measured included the postoperative mechanical ventilation time, ICU and hospital stay, postoperative drainage time, postoperative troponin T level, pain severity evaluated via a numerical rating scale, and the total consumption of opioids in both groups of patients.

Results
Overall, 57 patients were analyzed – 29 in the ERAS group and 28 in the standard care group. The time of mechanical ventilation, thoracic drainage, and ICU and hospital stay was shorter in the ERAS group than in the standard care group. The pain was less intense in the ERAS patients, and the postoperative opioid demand was reduced. Moreover, the increase of the postoperative troponin T concentration was lower in the ERAS group.

Conclusions
Our study showed that ERAS protocol implementation could improve patient outcomes after OP-CABG surgery.

keywords:

patient-controlled analgesia, coronary artery bypass graft, Enhanced Recovery After Surgery, erector spinae plane block, numerical rating scale
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