Table 2. ERAS protocol version 2.0.

Intervention

ERAS TLIF

Pre-operative counseling about nutritional optimization, including increased protein and calorie intake, as well as optimization of existing medical conditions

Pre-operative counseling regarding discharge location and inpatient rehabilitation centers

Pre-operative carbohydrate loading

Use of multimodal, non-opioid analgesia (600 mg oral gabapentin given pre-, liposomal bupivacaine intra-, and 1 g IV acetaminophen given post-operatively)

Post-operative ERAS rounds

Description

Accomplish the same goal as traditional MIS TLIF but minimizes the extent of soft tissue collateral trauma

Physiologic preparation for post-operative catabolic and insulin-resistant pathophysiologic state

Alleviate anxiety and temper the psychological stress response

Promote insulin sensitivity, reduce incidence of post-operative nausea, vomiting, constipation, and ileus

This technique reduces the need for post-operative opioids, thus promoting faster recovery

Rounding by an ERAS team member helps to facilitate compliance, coordinate early mobilization, assess adequacy of analgesia, and assist with acquisition of braces and walkers

ERAS, enhanced recovery after surgery; TLIF, technique for lumbar interbody fusion; IV, intravenous; MIS, minimally invasive.