Accelerating Remobilization Time Following Spine Surgery Using Enhanced Recovery After Surgery: A Randomized Controlled Trial

IF 0.4 Q4 NEUROSCIENCES

Archives of Neuroscience Pub Date : 2023-05-31 DOI:10.5812/ans-133609

Arash Heroabadi, Sahar Adeli, H. A. Varpaei

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Abstract

Background: The enhanced recovery after surgery (ERAS) protocol encompasses a set of evidence-based interventions implemented preoperatively, intraoperatively, and postoperatively. Objectives: This study aimed to assess the impact of applying an accelerated recovery method on remobilization time in patients undergoing spinal surgery compared to a control group. Methods: This randomized controlled trial took place at Shariati Hospital in Tehran, Iran. Eligible participants scheduled for elective spine surgery were enrolled in the study. Remobilization was defined as the patient's ability to independently leave the bed and ambulate. The ERAS protocol, derived from recommendations by the ERAS Society, was implemented. Total intravenous anesthesia was administered for induction and maintenance. The means of variables between the control and intervention groups were compared using an independent t-test. Changes in patients' pain intensity over time were examined through a repeated-measures ANOVA test. Multiple regression analysis was conducted to identify predictors of remobilization time. Results: A total of 70 patients (mean age 47.56 ± 14.08) were included in the study. The control group exhibited a significantly longer hospital stay compared to the ERAS group (46 h vs. 32 h). Furthermore, the ERAS group demonstrated a significantly shorter remobilization time after surgery compared to the control group (18 h vs. 8 h) (P < 0.001). Both groups exhibited a downward trend in overall pain, with the ERAS group experiencing a significantly faster pain reduction (η2 = 0.106, λ = 0.171, P < 0.001). Remobilization time exhibited significant correlations with pain intensity immediately after surgery (r = 0.651, P < 0.001), pain intensity one hour after surgery (r = 0.723, P < 0.001), pain intensity six hours after surgery (r = 0.391, P = 0.001), fentanyl dose (r = 0.728, P < 0.001), and length of hospital stay (r = 0.727, P < 0.001). Multiple regression analysis revealed that pain intensity one hour after surgery, fentanyl dose, and hospital stay significantly predicted remobilization time (F (9,60) = 22.751, P < 0.001). Conclusions: The implementation of the ERAS protocol yielded several beneficial outcomes, including reduced pain intensity, shorter ICU and hospital stays, and accelerated remobilization time. Pain intensity and opioid consumption (as analgesia) emerged as significant predictors of remobilization time.

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加速脊柱手术后的活动时间，增强术后恢复:一项随机对照试验

背景：术后增强恢复（ERAS）方案包括一套术前、术中和术后实施的循证干预措施。目的：本研究旨在评估与对照组相比，应用加速恢复方法对接受脊柱手术的患者再活动时间的影响。方法：该随机对照试验在伊朗德黑兰Shariati医院进行。计划进行选择性脊柱手术的符合条件的参与者被纳入研究。再活动被定义为患者独立下床活动的能力。根据电子逆向拍卖协会的建议制定的电子逆向拍卖协议已经实施。全静脉麻醉用于诱导和维持。使用独立t检验比较对照组和干预组之间的变量平均值。通过重复测量方差分析检验患者疼痛强度随时间的变化。进行多元回归分析以确定再活化时间的预测因素。结果：本研究共纳入70例患者（平均年龄47.56±14.08）。与ERAS组相比，对照组的住院时间明显更长（46小时vs.32小时）。此外，与对照组相比，ERAS组在手术后的再活动时间显著缩短（18小时vs.8小时）（P<0.001）。两组的整体疼痛都呈下降趋势，ERAS组的疼痛减轻速度明显加快（η2=0.106，λ=0.171，P<0.001）。再活动时间与术后即刻疼痛强度（r=0.651，P<0.001，和住院时间（r＝0.727，P＜0.001）。多元回归分析显示，术后1小时的疼痛强度、芬太尼剂量和住院时间显著预测了再活动时间（F（9，60）＝22.751，P＜001）。结论：ERAS方案的实施产生了一些有益的结果，包括疼痛强度降低、ICU和住院时间缩短，以及加速再活化时间。疼痛强度和阿片类药物消耗（作为镇痛）成为再活动时间的重要预测因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Archives of Neuroscience NEUROSCIENCES-

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期刊介绍： Archives of neuroscience is a clinical and basic journal which is informative to all practitioners like Neurosurgeons, Neurologists, Psychiatrists, Neuroscientists. It is the official journal of Brain and Spinal Injury Research Center. The Major theme of this journal is to follow the path of scientific collaboration, spontaneity, and goodwill for the future, by providing up-to-date knowledge for the readers. The journal aims at covering different fields, as the name implies, ranging from research in basic and clinical sciences to core topics such as patient care, education, procuring and correct utilization of resources and bringing to limelight the cherished goals of the institute in providing a standard care for the physically disabled patients. This quarterly journal offers a venue for our researchers and scientists to vent their innovative and constructive research works. The scope of the journal is as far wide as the universe as being declared by the name of the journal, but our aim is to pursue our sacred goals in providing a panacea for the intractable ailments, which leave a psychological element in the daily life of such patients. This authoritative clinical and basic journal was founded by Professor Madjid Samii in 2012.