Enhanced recovery after surgery and anesthetic outcomes in pediatric reconstructive urologic surgery

Pediatr Surg Int. 2021 Jan;37(1):151-159. doi: 10.1007/s00383-020-04775-0. Epub 2020 Nov 7.


Purpose: Enhanced recovery after surgery (ERAS) is a perioperative management strategy to hasten postoperative recovery. We examined the effects of a pilot implementation of ERAS for pediatric patients on anesthetic outcomes.

Methods: We performed a prospective case-control study utilizing an ERAS protocol in patients aged < 18 years undergoing urologic reconstruction that included a bowel anastomosis. Protocol elements included: multimodal analgesia, opioid minimization, and routine nausea/vomiting prophylaxis. ERAS patients were propensity-matched with historical controls. Outcomes of interest included maximum PACU pain score, time to first opioid, opioid-free days, and need for opioids on day of discharge.

Results: A total of 13 ERAS patients and 26 historical controls were included, with median ages 9.9 years (IQR 9.1-11) and 10.4 years (IQR 8.0-12.4), respectively. ERAS increased the percentage of patients who did not receive any intraoperative or postoperative opioids (0% vs 15%, p = 0.046 for both) and reduced maximum PACU pain score (3 vs 0, p < 0.001). The use of postoperative supplemental oxygen was decreased in the ERAS group (85% vs 38%, p = 0.013).

Conclusions: The implementation of an ERAS protocol appears to decrease postoperative pain, opioid usage, and positively impact other anesthetic outcomes in children undergoing urologic reconstructive surgery utilizing a bowel anastomosis.

Keywords: Enhanced recovery after surgery; Multimodal analgesia; Opioid-free; Opioid-sparing.

MeSH terms

  • Analgesia / methods*
  • Analgesics, Opioid / administration & dosage*
  • Anastomosis, Surgical / methods
  • Case-Control Studies
  • Child
  • Enhanced Recovery After Surgery*
  • Female
  • Humans
  • Intestines / surgery
  • Length of Stay / statistics & numerical data
  • Male
  • Pain, Postoperative / drug therapy*
  • Plastic Surgery Procedures / methods*
  • Postoperative Nausea and Vomiting / prevention & control*
  • Prospective Studies
  • Urologic Surgical Procedures / methods*


  • Analgesics, Opioid