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Background and AimsEnhanced Recovery After Surgery (ERAS) is a multidisciplinary, evidence-based protocol involving perioperative interventions to improve recovery. Although ERAS has been applied in neurosurgical procedures especially craniotomies, its role in endoscopic endonasal skull base surgeries remains unclear. This study aimed to establish the role of ERAS versus conventional anaesthetic care on postoperative recovery in such procedures.Methods60 participants (30 in each group) were randomly divided into two groups: Group I (ERAS protocol) and group II (Conventional anaesthetic technique)[figure 1]. The primary objective was to compare the difference between quality of postoperative recovery using Quality of recovery (QoR 15) scoring system in both the groups. The secondary objectives were to compare the day of ambulation, duration of hospital stay and postoperative pain scores.ResultsQoR15 score was comparable between both the groups at the baseline (p value 0.473). At 24 hours postoperatively, mean QoR 15 score was slightly higher in ERAS group (98.40±4.45) as compared to conventional group (96.56±4.40), but this difference was not statistically significant (p-value=0.11). ERAS patients ambulated earlier 2.30±0.535 days vs 3.30±0.915 days in conventional group with statistically significant difference (p<0.001) but the duration of hospital stay remained statistically non-significant (ERAS vs Conventional, 5.20±0.761 vs 5.47±0.86, mean difference = -0.27, p=0.209). NRS showed a tendency towards low pain scores in the ERAS group as compared to conventional group at all the time points from 1 hour to 24 hours post-surgery with p<0.001, showing statistically significant difference.Abstract EP129 Figure 1Institutional ethical committee certificate[Image Omitted. See PDF.]ConclusionsERAS protocol did not confer early recovery benefit as compared to conventional anaesthesia technique within first 24 hours postoperatively as measured by QoR 15 score in patients undergoing endoscopic endonasal skull base surgeries. However, ERAS offers significant advantages over conventional technique in terms of earlier ambulation and better pain management till 24 postoperative hours.

Background/Objectives: One common musculoskeletal disorder seriously compromising quality of life and burdening healthcare systems is lumbar disk herniation (LDH). LDH affects quality of life, healthcare costs, and occupational productivity, and it is expected to affect 40% of the population, mostly between 30 and 50 years of age. Methods: Over three years, this research assessed treatment results and the effect of comorbidities in a sample of 3074 individuals. Results: Surgical treatments—especially microdiscectomy—have a high success rate; over 90% of patients said their pain and functioning six months after surgery had improved significantly. Comparatively, conservative treatment approaches—physical therapy and epidural steroid injections—showed about 60% success in 70% of patients, indicating a clear need for early surgical assessment since 25% of originally conservatively managed patients needed surgery within one year. Significantly affecting treatment success are demographic variables; patients with preoperative Oswestry Disability Index (ODI) scores above 50 saw a 40-point improvement post-surgery compared to a 20-point gain for those following conservative therapy. High comorbidity rates—including obesity (mean of 148.33) and cardiovascular illnesses (mean of 530.33)—that are associated with extended recovery durations and complications were also seen in this research. Conclusions: Our results support a customized treatment plan, stressing the need of integrating thorough rehabilitation plans with prompt surgical interventions to maximize patient outcomes. This study emphasizes the need for a patient-centered treatment paradigm in controlling LDH, thereby trying to improve recovery and lower the healthcare load.

In recent years, the number of people using mobile applications to promote health and welfare has exponentially increased. However, there are fewer applications in the field of ERAS. How to promote the rapid rehabilitation of patients with malignant tumor surgery during perioperative period and the mastery of its long-term nutritional state is a problem to be solved. The purpose of this study is to design and develop a mobile application, and use Internet technology to better manage nutritional health to achieve rapid recovery of patients with malignant tumor surgery. This study is divided into three stages: (1) Design: use participating design to make the MHEALTH APP adapt to the clinical practice of nutritional health management; (2) Development: the WeChat Applet of Nutrition and Health Assessment (WANHA) developed using the Internet technology development, and web management programs. (3) Procedure test: patients and medical staff evaluate WANHA's quality (UMARS), availability (SUS), and satisfaction, and conduct semi-structured interviews. In this study, 192 patients with malignant tumor surgery, 20 medical staff used WANHA. Patients with nutritional risks are supported by supporting treatment. The results show that patients who have not been treated during the perioperative period, the incidence of postoperative complications (22.4%) and the average hospitalization time after surgery decreased significantly. The incidence of nutritional risks is nearly more than the preoperative level. 45 patients and 20 medical staff participated in the survey of WANHA's SUS, UMARS, and satisfaction. In the interview, most patients and medical personnel believe that the procedure can improve the current medical services and nutritional health knowledge levels, promote the communication of medical staff and patients, and strengthen the nutritional health management of patients with malignant tumors under the concept of ERAS. WeChat Applet of Nutrition and Health Assessment is a MHEALTH APP that enhances the nutrition and health management of patients with perioperative period. It can play a huge role in improving medical services, increasing patient satisfaction, and ERAS.

Background and AimsEffective postoperative pain management is essential for promoting early mobilization and functional recovery following total knee arthroplasty (TKA), particularly within Enhanced Recovery After Surgery (ERAS) protocols. Continuous femoral nerve block (CFNB) and local infiltration analgesia (LIA) are two widely used techniques, though their impact on hospital stay may differ. This study compares the analgesic efficacy and length of hospitalization associated with CFNB and LIA in TKA patients.MethodsA retrospective descriptive analysis was conducted involving 82 patients who underwent TKA with CFNB and subgluteal sciatic block in 2022, and 61 patients who received LIA between 2023 and 2024. All procedures were performed under spinal anesthesia. CFNB was maintained postoperatively with 0.2% ropivacaine at 4–6 mL/h. LIA was administered intraoperatively using 100–150 mL of 0.2% ropivacaine, dexamethasone, and adrenaline. Pain was assessed at 24 and 48 hours postoperatively, both at rest and during movement, using the Visual Numeric Scale (VNS). Median hospital stay was also recorded.ResultsIn the CFNB group, mean VNS scores at rest were 1.3 (24 h) and 2.1 (48 h), versus 4.86 and 4.1 in the LIA group. During movement, scores were 1.4 and 4.1 for CFNB, and 6.65 and 6.4 for LIA. Despite CFNB offering superior analgesia, the median hospital stay was longer (5.2 days) compared to the LIA group (3.2 days).Abstract P227 Table 1Summary of the resultsConclusionsIn conclusion, although CFNB provides better pain control, LIA is associated with a shorter hospital stay. These findings highlight LIA as an effective alternative for postoperative analgesia, supporting early mobilization and discharge within ERAS pathways.

Background Enhanced Recovery After Surgery (ERAS) has been widely applied in liver surgery since the publication of the first ERAS guidelines in 2016. The aim of the present article was to update the ERAS guidelines in liver surgery using a modified Delphi method based on a systematic review of the literature. Methods A systematic literature review was performed using MEDLINE/PubMed, Embase, and the Cochrane Library. A modified Delphi method including 15 international experts was used. Consensus was judged to be reached when >80% of the experts agreed on the recommended items. Recommendations were based on the Grading of Recommendations, Assessment, Development and Evaluations system. Results A total of 7541 manuscripts were screened, and 240 articles were finally included. Twenty-five recommendation items were elaborated. All of them obtained consensus (>80% agreement) after 3 Delphi rounds. Nine items (36%) had a high level of evidence and 16 (64%) a strong recommendation grade. Compared to the first ERAS guidelines published, 3 novel items were introduced: prehabilitation in high-risk patients, preoperative biliary drainage in cholestatic liver, and preoperative smoking and alcohol cessation at least 4 weeks before hepatectomy. Conclusions  These guidelines based on the best available evidence allow standardization of the perioperative management of patients undergoing liver surgery. Specific studies on hepatectomy in cirrhotic patients following an ERAS program are still needed.

Background and AimsCaesarean section (CS) is the most performed operation worldwide. In the UK 1 in 4 women give birth by CS. Poorly managed acute pain following CS can complicate recovery, new-born care, prolong hospital stay and risk the development of chronic post-surgical pain. The PROSPECT working group advises regional techniques post-operatively. A recent update highlights ilioinguinal-iliohypogastric blocks in reducing postoperative opioid- consumption and advocates erector spinae plane blocks following CS, as an alternative to neuraxial opioids. We investigated the current practice in our trust to ascertain what pain relief is given to women following such surgery.MethodsA survey was sent to all anaesthetist in our department. Data was collected anonymously with reference to their current practice. A literature search using Medline and Embase to explore the efficacy of regional blocks post CS provided a framework for best practice.Results39 relevant studies investigating fascial plane or peripheral nerve blocks for post CS pain were considered. Literature was unified in the beneficial outcomes of regional blocks in this patient group particularly in absence of neuraxial opioids, however 42% of anaesthetists surveyed at our trust never provide them.Abstract EP141 Figure 1Showing anaesthetists surveyed, who routinely work in Maternity at Bucks NHS Trust and prevalence of regional blocks provided post- operatively[Figure omitted. See PDF]Abstract EP141 Figure 2Snapshot of ‘which block’ is provided in the instances of regional analgesia being offered to this cohort of patients in maternity[Figure omitted. See PDF]Abstract EP141 Figure 3Illustrates opinions of Anaesthetist surveyed regarding most suitable scenario to offer regional analgesia post CS, if at all[Figure omitted. See PDF]ConclusionsInterest in regional anaesthesia is growing following the adoption of ‘Plan A blocks’ in the new curriculum. However, the list does not include a block for a Pfannenstiel incisions. Our results highlight a space for regional analgesia following CS, though further investigation regarding implementation is required. An enhanced recovery programme following CS including regional anaesthesia to compliment multi-modal analgesia might improve the daily lives of many women.

Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)Background and Aims Oncological breast surgery is associated with significant postoperative pain. PROSPECT guidelines recommend regional anaesthesia for postoperative pain management following mastectomy [1]. Single shot blocks with standard local anaesthetics are limited in duration. We aimed to compare two regional techniques that are currently used at our trust to prolong the duration of post operative analgesia.MethodsWe prospectively reviewed 37 mastectomies (September 2021 – March 2023). The patients either received serratus anterior plane catheters through which local anaesthetic was delivered for up to 72 hours postoperatively or preoperative serratus anterior plane blocks using Liposomal Bupivacaine. We compared patient satisfaction and quality of recovery scores in the two groups.ResultsThere was no clinically significant difference in use of rescue oral opioids in PACU or at home up to post operative day 2 between the groups. Post operative sleep quality was also similar apart from day 2 when Liposomal patients reported better sleep quality. Both patient groups reported high satisfaction scores with analgesia and recovery.Conclusions1. High patient satisfaction with both groups 2. Patients highly recommend both techniques. 3. Marginally better sleep quality in the group that received Liposomal Bupivacaine. 4. Both are valid techniques, providing similar pain relief and quality of recovery.References.docx