Nursing care in enhanced recovery after surgery (ERAS): Pathways for patients undergoing spinal surgery
, 
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Stephen Kivunja
- Clinical Nurse Specialist, Neurosciences, Western Sydney Local Health District, Westmead HospitalWestmead, Australia
- The University of Sydney, Faculty of Medicine and Health, Susan Wakil School of Nursing and MidwiferyCamperdown, Australia
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, Dr. Linda Nichols
Adjunct Researcher, University of TasmaniaTasmania, Australia
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and Jun 12, 2025
About this article
Published Online: Jun 12, 2025
Page range: 25 - 35
DOI: https://doi.org/10.2478/ajon-2025-0005
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© 2025 Caroline Woon RN et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
A summary of pre, peri and post-operative stages of medications in ERAS protocols from different institutions adapted from (Alboog et at, 2019; Ali et al_,2018; Ali et al_, 2019; Ali et al_; 2023; Bhatia & Buvanendran, 2019; Debano et al, (2021); Grasu et al_, 2018; Naftalovich et al_, 2022; Pahwa et al_, 2024; Soffin et al_,2019)
| ERAS Protocol/medication protocol (Host/Institution) | Type of surgery and primary study | Pre-operative | Intra-operative | Post-operative | Outcomes |
|---|---|---|---|---|---|
| Enhanced recovery after surgery society guidelines | Debang et al, (2021) Society Guideline | Manage expectations |
Multimodal analgesia, opioid sparing. |
Early mobilisation |
Optimisation of pain relief for patients |
| Rush University Medical Centre, USA | Spine surgery ( |
1,000mg IV acetaminophen 600mg Gabapentin Or 150mg pregabalin 10mg cyclobenzaprlne 10mg oxycodone Pregahalin 150 mg Oxycodone release 10 mg |
Propofol infusion at induction, inhaled anaesthesia, ketamine at induction, dexamethasone, fentanyl, methadone, lidocaine, acetaminophen (see below) Bupivacaine 0.5% with epinephrine 1:200,000 injected at incision site 20 mL per side if patient weight <70 kg 30 mL per side if patient weight ≥70 kg Acetaminophen 1,000 mg IV Dexamethasone 10 mg IV Ondansetron 4 mg IV Famotidine 20 mg IV Oral pain medications if possible, in recovery room |
NSAID cold compres5es applied to surgical area Pregabalin 75 mg q12h orally Cydobenzaprine 10 mg q8h orally Tramadol 50 mg q6h Oxycodone immediate release 5 mg q4h as needed for pain (NRS >3), opioid naïve patients 10 mg q4h as need for pain (NRS >4), opioid tolerant patients Cydobenzaprine 10 mg PO prn for spasms Hydrocodone 10 mg plus acetaminophen 325 mg 1 tablet as needed for pain (NRS 1–5) 2 tablets as needed for pain (NRS 6–10) |
Potential to make difference to length of stay. |
| Weill Cornell Medical College, USA | Minimally invasive lumbar decompression spine surgery ( |
oral acetaminophen (1000 mg) and gabapentin (300 mg) in the preoperative holding area | Total intravenous anaesthesia, ketorolac, lidocaine, dual antiemetic, prophylactic therapy | Acetaminophen, NSAIDr Two 50mg tramadol or 5mg oxycodone based on NRS pain score | Potential for quicker discharge and reduced opioid use. |
| Retrospective Matched cohort study (n = 18) | boluses of fentanyl (1–2 μg/kg, titrated to effect) or Dilaudid (up to 2 mg total). accordingto the judgment of the anesthesiologist to achieve optimal hemodynamic and anesthetic conditions for surgery. All patients received infusions of the following: 1) propofol (50–150 μg/kg/hr), adjusted to maintain the mean arterial pressure within ± 20% of each patient’s baseline value, 2) ketamine (0.1–0.5 mg/min), >and 3) lidocaine (2 mg/kg/hr until closure of the surgical incision). Inhaled halogenated agents (isoflurane or sevoflurane) were permitted, up to 0.5 minimum alveolar Patients concentration (MAC), as needed. Dual antiemetic therapy with dexamethasone (4 or 8 mg) and ondansetron (4 mg) were provided. Ketorolac (15 or 30 mg, according to age and weight) was given durjng surgical closure. | Patients with reported NRS scores ≤ 4 should be treated with non-opioid analgesics (acetaminophen, ketorolac-, gabapentin, and/or non-pharmacotherapies, including ice, distraction, and position changes); for those with NRS scores 5–7, patients may receive two 50-mg doses of tramadolif needed; and for those with NRS scores 8–10, patients may receive a 5-mg oxycodone. Further escalation of opioids requires assessment by the anesthesiologist. PONV are treated with metoclopramide (10 mg intravenously) or ondansetron (4 mg). prescribed scopolamine (1.5 mg transdermal). | |||
| University of Western Ontario, Canada | Spine surgery ( |
Pregabalin, gabapentin 0.2mg per KG, methadone | Selective COX-2 inhibitors, ketamine administration (bolus or infusion), tramadol, analgesics mixture | NA | Recommend a combined use of gabapentiniods, ketamine, and opioids to achieve optimal analgesia |
| Perelman, School of Medicine, University of Pennsylvania, USA | Spine surgery ( |
Education, nutrition, diabetes management, smoking cessation counselling, chronic opioid screen use, obstructive sleep apnoea screen, and discharge planning. |
Metabolism management, multimodal analgesia, safe spinal surgery checklist, early mobilisation and wound care. |
Clinical team communication, wound care management, post-acute care neurosurgery triage pathway. |
ERAS protocol greatly improves postoperative mobilization and ambulation and, most importantly, has the potential to safely reduce opioid use both in the perioperative period and at 1 month after surgery, with important potential for relief of chronic opioid dependence. |
| University of Texas, USA | Spine surgery for metastatic tumours ( |
Education, sedation and anxiety management, pain management and pre-op fasting |
Fluid, temperature and transfusion management, surgical management |
Early ambulation, early oral intake, DVT prophylaxis, physical therapy |
Improved analgesia and decreased opioid consumption in the perioperative care of patients undergoing spine surgery for metastatic tumors |
| Westmead ERAS Protocol, Australia | Elective spiral (lumbar and cervical) decompression surgery ( |
Modern fasting, prioritised as first or second surgical case. Preceeded by: Period (1) Operative consultation (operative plan, patient education, ERAS inception) Period (2) Preadmission clinic (patient re-education, ERAS principles &reinforcement) |
Post-operative nausea & vomiting prophylaxis |
Early mobilisation Multimodal analgesia Same day discharge (within 4 hours) |
Early discharge post surgery |