New surgery approach at Montreal Children's Hospital cuts recovery times, opioid use
Surgeons at the Montreal Children's Hospital have started using a new approach to help young patients recover from surgery that has already led to shorter hospital stays and fewer opioid prescriptions.
The Enhanced Recovery After Surgery (ERAS) model is an approach that puts the full recovery of the patient at the centre of any procedure.
It's a model used for adult patients and is now being used in pediatrics.
In July, 16-year-old student-athlete Victor Terme underwent surgery to fix a sunken sternum.
"When I pushed myself a lot, I felt really exhausted," he said.
He tried physiotherapy and vacuum therapy, but, in the end, his only option was surgery, a frightening prospect for him and his family.
"I was very scared because I knew it takes a long time to recover, maybe four weeks of hospitalization in some cases, and also the use of a lot of opioids which can give addiction," said his mother Claudia Maios.
The new approach, spearheaded by Children's chief of pediatric surgery Dr. Sherif Emil, dramatically improved Terme's recovery time.
"I was released from the hospital after one day," said Terme.
"So we are not just [talking about] issues that pertain to function; we're looking at issues that pertain to the entire family dynamic that revolves around the child," said Emil.
For surgeries like the one Terme underwent, liquid nitrogen is used to freeze the nerves in the chest, which numbs the pain for two to three months.
"Once we've enhanced the recovery with this new pain modality and we've standardized the care, so all the patients are treated according to a protocol, not according to the whims of the surgeon or the anesthesiologist, we were able to cut the hospital stay down from six to seven days to one night," said Emil.
For the teenage patient, the effects of the technique were immediate.
"There was no real pain, other than the numbness at the start, during the first week," he said. "But after the first week, there was no pain at all."
Daniel Chow is a first-year medical student and underwent the same surgery as Terme in 2015. He said he spent a week in the hospital and was in pain for three months after that.
Now he can see the positive impact the ERAS model is having on others.
"It just makes me grateful, really thankful, and I'm extremely happy for those families because, as Dr. Emil said, ERAS is not only a patient thing, it's a family thing," said Chow.