Q&A Topic: Enhanced Recovery for Women after GYN-Surgery
Elisa E. Burns, MD, FACOG
Q. What’s the advancement you’re most excited about in the field of gynecology surgery?
A. We’re partnering with women, focusing not only on what happens after surgery, but also before and during. Our ERAS (Enhanced Recovery After Surgery) is a surgical pathway that begins the minute a woman is scheduled for gynecological surgery. We use evidence-based guidelines designed to optimize hydration, nutrition and pain control prior to surgery – leading to a faster, safer and more comfortable recovery after. While ERAS is not only used in gynecological surgeries, it’s particularly exciting for women. Many of my patients are astonished at how fast they recover after surgery.
Q. What is happening prior to surgery that helps a patient recover after surgery?
A. If you’re in better shape before surgery, you’ll do better after. Think about it like this: If you study hard for an exam, you’re likely going to pass. But if you’re unprepared, you won’t do as well. If you’re a smoker, for example, we offer you a free smoking cessation program to encourage you to quit. Eating well before surgery is also key. It helps you maintain a healthy weight, promotes digestive health, decreases your risk for infection, and gets your immune system in good shape so you’re better able to withstand the stress of surgery.
Q. How does ERAS help women manage their pain after surgery?
A. Surgery is not pain free. When you work out, you expect to feel sore. When you have surgery, you should expect some discomfort and pain. Several pain management techniques during surgery help streamline the healing process with particular impact on pain after surgery. We give oral non-narcotic medicine, nerve blocks to directly target pain in the surgical site, and very long-acting local aesthetic that works up to 72 hours after surgery. Your pain is now managed and controlled in a way that helps you recover faster. By removing potentially addictive opioids and narcotics from the equation, women have improved bowel function after surgery, little to no nausea or vomiting, and better mobility. Narcotics can cause grogginess, and an inability to move around. Now, one to two hours after surgery, we’re walking with our patients in the recovery room. Mobility speeds up recovery and helps prevent blood clots and pneumonia.
Q. How else is ERAS different from traditional protocol?
A. Aside from unique pain management strategies, the ERAS protocol takes a different approach when it comes to IV fluids. In the past, women were told to fast before gynecological surgery and we’d overload them with fluids via IV. We’ve significantly reduced the amount of fluids we administer during surgery. We now know that too many IV fluids can cause internal swelling and lead to improper healing during recovery. Instead, my patients are excited to learn that they can have water and Gatorade, and take nutritional supplements up until their surgery. This helps keep my patients well hydrated for surgery.
Learn More About Dr. Burns
Director, Quality & Outcomes
Institute for Robotic & Minimally Invasive Surgery
Northern Westchester Hospital
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