Randomized Controlled Trial Comparing the Outcomes of Enhanced Recovery After Surgery and Standard Recovery Pathways in Laparoscopic Sleeve Gastrectomy.
Prabhakaran S,Misra Shivanshu,Magila M,Kumar S Saravana,Kasthuri Sudarsan,Palanivelu Chinnusamy,Raj P Praveen
PURPOSE:The enhanced recovery after surgery (ERAS) pathway is an evidence-based perioperative pathway that results in less pain, earlier recovery, and lower complication rates. Studies to prove their efficacy over standard recovery pathways in the Indian population are scarce. Our study intends to compare the outcomes of these pathways in the Indian community focusing on hospital stay, postoperative pain, and time for rescue analgesia. MATERIALS AND METHODS:This is a single-blinded RCT involving 112 patients who underwent laparoscopic sleeve gastrectomy (LSG). The groups were divided into ERAS and standard pathway arms by closed envelope technique. The primary outcome was the length of hospital stay, while the secondary outcomes included pain score; postoperative nausea, and vomiting (PONV); time for rescue analgesia; and ambulation. RESULTS:Of 112 patients included, 56 were allocated in the ERAS group, and the remaining 56 were included in the standard pathway group. We found no significant differences in the baseline characteristics between the two groups. Mean hospital stay was significantly lower in the ERAS group compared to the standard group (p = 0.003). In comparison to the standard group, ERAS patients were ambulated early, and the difference was highly significant (p < 0.001). Pain scores between the two groups showed a significant difference during the 4th hour and 8th hour. We also found a significant variation between the time for first rescue analgesia and the two groups (p < 0.001). CONCLUSION:Patients who followed ERAS protocol were found to have shortened hospital stay, decreased pain, early ambulation, and reduced need for rescue analgesia. TRIAL REGISTRATION:ClinicalTrials.gov Identifier: NCT03191318.