This program will aim to describe the major concepts and goals of Enhanced Recovery After Surgery (ERAS), and translate these ideas from human medicine to veterinary medicine. While the concept of ERAS was developed in 2001 by human surgeons with the goal of improving recovery for patients undergoing colorectal surgery, it has become widely adapted and shown to improve outcomes among various surgical specialties. Key components to successful ERAS protocols include the development of a multidisciplinary team for each patient, an evidence-based approach to designing care protocols, multimodal strategies for improving recovery and limiting complications, and continuous audit of these protocols to evaluate results. Among the core goals of ERAS protocols are maintaining homeostasis and minimizing stress, which include supporting the patient’s nutritional status throughout the perioperative timeframe and optimizing pain control. Patient optimization is critical throughout the preadmission, preoperative, intraoperative, and postoperative phases, and typically includes strategies such as medical optimization prior to the procedure, nutritional and gastrointestinal support, minimally invasive surgery, regional and opioid-sparing anesthesia, and early intake of food and fluids post-operatively.
This lecture will focus primarily on strategies for implementing ERAS techniques in small animal veterinary medicine. Among the major risks associated with general anesthesia are gastrointestinal signs such as nausea, vomiting, and gastrointestinal reflux, which may contribute to further complications including regurgitation and aspiration. These complications may result in increased patient morbidity and mortality, prolonged length of stay in hospital, increased cost of care, and poorer overall outcomes. Appropriate fasting times, preoperative nutrition, pharmacologic gastrointestinal support, and the judicious use of opioid analgesics have been shown to reduce the incidence of postoperative nausea and vomiting, promote early return to eating, and improve postoperative outcomes. Opioid-free and opioid-sparing anesthetic protocols will be reviewed, with multimodal analgesic strategies relying on medications such as dexmedetomidine, ketamine, and lidocaine, as well as neuraxial and locoregional techniques. Finally, a brief update on fascial plane and peripheral nerve blocks in small animal veterinary patients will be discussed, as well as how these techniques may be applied in patients undergoing a variety of surgical procedures to provide optimal analgesia and promote smooth recoveries.
