Enhanced Recovery After Surgery (called “ERAS”) is a care plan that was designed for you by your Heritage Valley Health System (HVHS) Surgery and Anesthesiology Teams. The care plan helps to: prepare your body for surgery, recover safely, and return home as soon as possible after your surgery.
Why do we use an ERAS approach?
The ERAS pathway helps you to recover quickly and lowers the chances of you having any problems after your surgery. This pathway helps you and your team work together to:
- Keep your hospital stay short
- Keep your pain level at a mutually agreed upon level
- Get out of bed and walk within 24 hours
- Allow you to eat and drink as soon as it is safe for you
- Listen to your concerns and explain things clearly
- Make sure you are happy with your care
What should I expect before surgery?
After discussing your surgery with the surgeon, a member of your surgeon’s team will talk to you about your role in the ERAS pathway. Your team will also give you important details about how to prepare your body for surgery which includes:
- Limit smoking. We encourage you to quit completely. If you feel this will be hard for you, please ask your primary care doctor, surgeon, or anesthesia team member for advice on ways to help you to quit.
- Increase your strength and improve your recovery by walking at least 30 minutes a day before your procedure. You will be expected to walk after your procedure also. Exercise before surgery will help you recover after your surgery.
- Review and discuss your current medications with your team. Avoid herbal supplements and ask your surgeon about medications you may be currently taking that can thin your blood and increase bleeding during surgery.
- At least a week before surgery, eat healthy foods to fuel your body with the nutrients that it will need during surgery. This leads to a faster recovery after your procedure, and a faster recovery may mean that you can go home sooner!
Studies have shown that what you do and what you eat before your surgery can reduce complications and speed your recovery! General guidelines suggest one week prior to your surgery you will want to increase your consumption of foods and beverages rich in carbohydrate and protein to provide your body with extra nutrients that can be used during your surgery. You may even be asked to drink Gatorade® before surgery. In this brochure, you will find guidelines for consideration as well as a sample menu. Your surgeon and their office staff will provide information specific to you and they along with your primary care doctor will develop an individualized meal plan on this if needed.
What will happen in the operating room?
You will be carefully monitored by a team of people throughout your entire stay! This team will make sure you and your family are kept informed throughout your stay, ensure you are comfortable, manage any pain you may experience, and address any concerns you may have throughout your stay at HVHS.
How will my pain be managed?
ERAS care plans are designed to minimize side effects such as excessive drowsiness, confusion, and constipation from commonly used pain medications. These side effects could lengthen your hospital stay and can make recovery after surgery difficult.
While some degree of discomfort is to be expected, the team will work to control your pain so that you can do what is needed to recover from your surgery as quickly as possible. Medications that may be used to help manage your pain include:
- Aleve (naproxen)
- Celebrex (celecoxib)
- Lyrica (pregabalin)
- Motrin (ibuprofen)
- Toradol (ketorolac)
- Tylenol (acetaminophen)
While opioid medications are often utilized to address pain, other alternatives may be in your best interest and should be considered when creating your individualized plan of care. These alternatives may include:
- Epidural Catheters
- Nerve Blocks
- Non opioid medications such as: Ofirmev (intravenous acetaminophen), Caldolor ( intravenous ibuprofen), Gabapentin, and Ketamine
If you are on opioids for chronic pain, we will not make any adjustments to your chronic pain management and will work with your doctors, as needed, to make sure your pain is managed.
Recovery from surgery takes both dedication and hard work, and we, along with your primary care provider, will work together to address postoperative pain.
What will happen after my surgery?
After your surgery, you will go the Postoperative Anesthesia Care Unit, called the PACU. PACU nurses will be with you to closely watch your blood pressure, heart rate, and oxygen levels. Your nurses will also give you any medicines you need. Your HVHS care team will update your family on how you are doing.
From the PACU you may be discharged home or you may be moved to a post-operative surgical unit in the hospital for your recovery depending on what you and your surgeon discussed BEFORE the surgery. Your nurse and the other members of your HVHS care team will help guide you through your recovery by helping you move around safely, remove bladder catheters or tubes that were placed before or during surgery as soon as possible and letting you know when you can start drinking fluids and eating solid food. It is important for you to get out of bed, sit in a chair, and walk as soon as possible after surgery and to do this as often as you can.
Dietary Guidelines and Sample Meal Plan
The week before surgery:
- Increase your daily activity by 30 minutes per day (refer to surgeon’s recommendations)
- Eat high protein and high carbohydrate meals (refer to sample patient menus above). If on bowel prep, follow the instructions from your surgeon.
- Stop smoking and decrease alcohol consumption.
- Plan your clear liquid drinks for the night before surgery
Night before surgery:
- Do not eat after midnight (If on bowel prep, follow the instructions from your surgeon).
- Continue to drink non-carbonated clear liquids after midnight until 3 hours prior to surgery
- Non-diabetic patients, drink 20 oz. of Gatorade ® in the hour before you are told to stop drinking. Why Gatorade? It helps to increase your comfort before surgery and to decrease your nausea after surgery. The carbohydrates in Gatorade help reduce your body’s stress response to surgery.
- If you have Diabetes, please drink 20 oz. of Low Calorie G2 in the hour before you are told to stop drinking (Do not drink Gatorade ® or sugar containing liquids unless your sugar is low).
- Follow instructions regarding all medications prior to surgery.
- Arrive to hospital at time designated.
- What questions do I have for my surgery team?
- What medications do I need to hold before my surgery and what day do I hold them?
- What type of foods are right for me before surgery?
- What types of drinks are right for me before surgery?
- How will I increase my activity before surgery?
- When is the last time I can eat or drink before my surgery?
- Who will I have help me after surgery at home?