Are fear of pain and time of recovery after breast reconstruction surgery some of your biggest concerns? If so, Episode 8: ERAS Protocol in Breast Reconstruction, with Dr. Minas Chrysopoulo will give you information about ERAS (Enhanced Recovery after Surgery) protocol many large volume centers are now using for DIEP flap and other types of breast reconstruction.
Dr. C is the president of PRMA in San Antonio and the developer of the Breast Advocate app. Both of these sites have more information about ERAS protocol as well as the DiepCJourney blog and DiepC Foundation YouTube channel.
Why Use ERAS?
There is a shared interest Dr. C and I share in having this conversation. He states it very clearly at the beginning of the podcast. The number one beneficiary is patient experience and patient outcomes. There are substantial data and evidence-based studies about results of using ERAS and the benefits it offers patients. In fact, follow the directions below and use the Breast Advocate app to search the topic.
Different institutions have different variations of ERAS. Additionally, ERAS protocol is used across specialties other than breast reconstruction that can include cardiac surgery, GI surgery, and breast surgery. So, for an listeners or readers facing a surgical procedure, it is worth asking your surgical team if they use ERAS protocol for you or a loved.
What are the Benefits of ERAS?
Here is a list of the benefits from Dr. C’s interview:
- Prepares the patient for surgery.
- Improves pain control without the dependence on narcotics.
- Makes the overall recovery process shorter.
- Shortens hospital stay getting people home a lot sooner.
- As part of all of ERAS, it helps people get up out of bed and walk sooner.
- Patients start eating sooner after a major surgery.
ERAS generally just speeds everything up and shortens the entire recovery process. This helps decrease the risk of complications. And yes, Dr. C, I have spoken to a fair amount of Journey members over the past few years since my own DIEP flap who have truly benefitted from ERAS protocol.
Education About ERAS Begins with the Patient
Dr. C points out it starts with setting patient expectations at the consult before surgery takes place. Taking the time to explain the benefits of ERAS to patients preoperatively is very important for patient buy in. Letting patients know dependency on narcotics means, instead of using narcotics every four to six hours as was the protocol prior to ERAS, now it is used only as needed for break through pain.
The term “base line control” in terms of pain is important to understand. Using a combination of a non-steroidal, extra strength Tylenol, and low dose Gabapentin are the three medications used with adjustments made for those who may not tolerate any one of these pain control medications for individual reasons. This cocktail of medications is given around the clock for two weeks in a scheduled manner. Whether you think you need it or not, you take it. This establishes the “base line pain control”.
To clarify, when I had my DIEP flap, the pain pump I was referring to in the conversation is the PCA, patient-controlled analgesia. After my double mastectomy, seven months prior to my DIEP flap, I used the On-Q pain ball that delivers a local anesthetic to the breast area. The difference in the two, the PCA (patient-controlled analgesia) was the narcotic portion used prior to ERAS. This is what made me have the woozy, zonked out feeling patients no longer experience with the non-narcotic protocol of ERAS. When we say it has been a game-changer, it truly has. A list of difference from now and when I had my DIEP flap without ERAS:
- The catheter is removed the morning after surgery.
- Patients are eating solid foods the day after surgery.
- The body returns to a more normal state, bowels moving sooner, due to ERAS.
Listen to the benefits of ERAS by clicking on the link below to listen, and learn why this truly has been a game changer and improves recovery for patients. Thanks again for joining the DiepCJourney podcast Dr. C!