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More information: Enhanced recovery after surgery (ERAS)
Enhanced recovery after surgery (ERAS) is a multimodal, multidisciplinary approach to the care of the surgical patient. Implementation involves a team of surgeons, anesthetists, an ERAS coordinator (often a nurse or a physician assistant), and staff from units that care for the surgical patient.
ERAS protocols are designed to achieve early recovery after surgical procedures by maintaining pre-operative organ function and reducing the profound stress response following surgery. Key elements of ERAS protocols:1Melnyk M, Casey RG, Black P, Koupparis AJ. Enhanced recovery after surgery (ERAS) protocols: time to change practice? Canadian Urological Association Journal. 2011;5(5):342-348.
- Preoperative counseling
- Optimization of nutrition
- Standardized analgesic and anesthetic regimens
- Early mobilization
Resources on ERAS
Immunonutrition involves using specific nutrients to influence the activity of the immune system. Arginine, glutamine, branched chain amino acids, omega-3 fatty acids, and nucleotides have been studied most often.2Calder PC. Immunonutrition in surgical and critically ill patients. British Journal of Nutrition. 2007;98 Suppl 1:S133-S139.
- Substantially fewer infections and infectious complications but no evidence of an effect on 30-day mortality after elective curative surgery for a solid malignant tumor among people treated with immunonutrition orally before surgery (and some continuing after surgery) compared to controls not receiving immunonutrition in a meta-analysis of 22 RCTs3Buzquurz F, Bojesen RD, Grube C, Madsen MT, Gögenur I. Impact of oral preoperative and perioperative immunonutrition on postoperative infection and mortality in patients undergoing cancer surgery: systematic review and meta-analysis with trial sequential analysis. BJS Open. 2020 Oct;4(5):764-775.
- Substantially fewer infections and shorter hospital stays, but no evidence of an effect on mortality after surgery among people receiving immune-enhancing nutrition compared to standard enteral nutrition in meta-analyses of 12,4Beale RJ, Bryg DJ, Bihari DJ. Immunonutrition in the critically ill: a systematic review of clinical outcome. Critical Care in Medicine. 1999 Dec;27(12):2799-805. 11,5Heys SD, Walker LG, Smith I, Eremin O. Enteral nutritional supplementation with key nutrients in patients with critical illness and cancer: a meta-analysis of randomized controlled clinical trials. Annals of Surgery. 1999 Apr;229(4):467-77. and 22 RCTs,6Heyland DK, Novak F et al. Should immunonutrition become routine in critically ill patients? A systematic review of the evidence. JAMA. 2001 Aug 22-29;286(8):944-53. many of which included people with cancer
- Fewer infectious and noninfectious complications after surgery, shorter hospital stays and better clinical outcomes among people with gastrointestinal cancer undergoing surgery with enteral immunonutrition before, during and/or after surgery compared to standard enteral nutrition in a meta-analysis of 27 RCTs7Song GM, Tian X et al. Immunonutrition support for patients undergoing surgery for gastrointestinal malignancy: preoperative, postoperative, or perioperative? a bayesian network meta-analysis of randomized controlled trials. Medicine (Baltimore). 2015 Jul;94(29):e1225.
More about safety
Preclinical evidence of greater tumor growth and metastasis among people treated with morphine
- Mammary tumor growth in rodents treated with morphine8Gupta K, Kshirsagar S et al. Morphine stimulates angiogenesis by activating proangiogenic and survival-promoting signaling and promotes breast tumor growth. Cancer Research. 2002 Aug 1;62(15):4491-8.
- Immune escape (a key mechanism of cancer progression and metastasis) of human non-small cell lung cancer cells treated with morphine-3-glucuronide9Wang K, Wang J et al. Morphine-3-glucuronide upregulates PD-L1 expression via TLR4 and promotes the immune escape of non-small cell lung cancer. Cancer Biology & Medicine. 2021 Feb 15;18(1):155-171.
Barbara MacDonald, ND, LAc
MacDonald B. The Breast Cancer Companion—A Complementary Care Manual: Third Edition. Self-published. 2016.
Naturopathic physician Barbara MacDonald provides information about breast cancer, its conventional treatment, and natural approaches to enhancing treatment, managing side effects, reducing risk of recurrence, and healthy living after cancer treatment is completed.
Gurdev Parmar, ND, FABNO, and Tina Kaczor, ND, FABNO
In their Textbook of Naturopathic Oncology: A Desktop Guide of Integrative Cancer Care. 1st edition, naturopathic oncologists Gurdev Parmar and Tina Kaczor discuss considerations for naturopathic care before and after surgery to optimize recovery, reduce pain, reduce risk post-surgical infections, and possibly reduce risk of metastasis.
Anesthesia and postoperative pain control
Pharmaceutical pain control
Opioid-based intravenous patient-controlled analgesia (meta-analysesa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study)
Transabdominal plane (TAP) blocks
Non-pharmaceutical pain control
Keep reading about integrative approaches to surgery
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