Authors: Pandit S et al.
A & A Practice. 19(11):e02075, November 2025. DOI: 10.1213/XAA.0000000000002075
Summary
This randomized controlled trial evaluated whether an Enhanced Recovery After Surgery (ERAS) protocol improves perioperative outcomes compared with conventional care in patients undergoing craniotomy for anterior circulation intracranial aneurysms. Although ERAS pathways are well established in other surgical domains, their role in elective aneurysm surgery has been less clearly defined.
Forty-six adult patients with good neurological status (WFNS grade 1, ASA I–II) were randomized equally to an ERAS protocol or conventional perioperative management. The primary outcome was postoperative hospital length of stay, while secondary outcomes included intraoperative opioid use, postoperative pain and analgesic requirements, ICU length of stay, complications, functional recovery, and patient satisfaction.
Overall hospital length of stay did not differ significantly between groups. However, patients managed with the ERAS protocol experienced a significantly shorter ICU stay, with a reduction of approximately 8 hours compared with conventional care. Intraoperative fentanyl requirements were substantially lower in the ERAS group, reflecting more effective multimodal analgesia and opioid-sparing strategies. Postoperative pain control and patient satisfaction were also superior in the ERAS cohort, with higher satisfaction scores reported.
Although total hospital length of stay was not reduced, the combination of earlier ICU discharge, reduced opioid exposure, and improved patient-reported outcomes suggests that ERAS principles can be safely applied to selected patients undergoing aneurysm surgery. The authors note that the small sample size may have limited the ability to detect differences in hospital length of stay and functional recovery.
Key Points
ERAS did not significantly reduce total hospital length of stay after craniotomy for intracranial aneurysm.
ICU length of stay was significantly shorter with ERAS compared with conventional care.
Intraoperative fentanyl consumption was markedly lower in the ERAS group.
Patient satisfaction and postoperative pain outcomes were improved with ERAS.
ERAS protocols appear feasible and beneficial in carefully selected aneurysm surgery patients.
Thank you for allowing us to review and summarize this randomized trial from A & A Practice.