Frequently Asked Questions

The Enhanced Recovery pathway helps you to recover quickly and lowers the chances of you having any problems after your surgery. This pathway also helps you and your team work together to:

• Help you to go home the same day as surgery, when possible
• Keep your pain level under control
• Help you to get out of bed and walk more quickly after surgery
• Minimize the risk of post-operative nausea and vomiting
• Listen to your concerns and explain things clearly
• Make sure you are happy with the care you get at UNC

No, they are simply protocols for expected best practice. There is no ongoing “experimentation”, although we do continue to refine, enhance, and do research using our protocols, in order to ensure the best quality of care possible for our patients.

During your clinic visit, a nurse will discuss the Enhanced Recovery pathway with you.
After discussing your surgery with the surgeon, a member of their team will provide you with a special carbohydrate drink that you will drink on the day of surgery, as well as talk with you about ERAS. Next, an appointment will be made for you in the Pre-Care Clinic. In the Pre-Care Clinic, you will have blood work performed and receive additional preoperative instructions.

You will be carefully monitored in the OR during your surgery. An anesthesiologist and another anesthesia provider, a resident doctor or nurse anesthetist, will be watching over you at all times. This anesthesiology team will be also be giving you medicines to keep you asleep and comfortable. You may also receive other medications during your surgery such as medicine to help control your blood pressure and medicines to prevent nausea after surgery. Warm blankets, warm IV fluids and air warmers keep you warm during your surgery. Your blood pressure is closely monitored to reduce your risk for heart attack, stroke, and kidney problems.

After your surgery, you will go the Postoperative Anesthesia Care Unit, called the PACU. PACU nurses will be with you to closely watch your vital signs (blood pressure, heart rate, and oxygen levels). Your nurses will also give you any medicines you need. Your UNC team will update your family on how you are doing. When you are ready, you will be moved to a post-operative surgical unit in the hospital for your recovery. It is important for you to get out of bed, sit in a chair, and walk starting the day after your surgery. Do this as often as you can. Your nurse will help you move around safely. If possible, your bladder catheter and your nasogastric “NG” tube will be taken out the day after your surgery. Your UNC surgery team will tell you when you can start drinking fluids and eating solid food. Your team will tell you when it is safe for you to go home.

The nerves that supply the feelings of sensation and pain start in the spinal cord. These nerves leave the spinal cord through a space called the “epidural space.” This space is just a few centimeters under your skin beneath the bones of your spine. An epidural for pain management is a tube, called a catheter, that is inserted into the epidural space. This small catheter coats the nerves that supply the sensation of pain with a numbing medicine. This medicine blocks the pain until the catheter is taken out. This will make you numb on your belly, but you can still feel and move your arms and legs. A special pump is attached to the tubing. The pump gives you medicine through your epidural to keep you comfortable. This kind of pain control lowers the need for other pain medicines that have more side effects, such as nausea, sleepiness and itching.

You may or may not receive an epidural. If it is indicated for your surgery and if it is appropriate for you to get one, then your epidural will be administered before you go to the OR. Before the epidural catheter is inserted, you will receive a medicine to help you relax and lower any anxiety you may be feeling. Being relaxed will help you stay in the right position while the catheter is being inserted.

You will be sitting up in bed with your shoulders and upper back slouched while your epidural is put in. It is important for you to sit very still while the epidural is being placed. The only pain you will feel is a small pinch and a slight burning sensation from the numbing medicine that is put into the skin of your back. The epidural is inserted through the numbed area. You may feel some pressure, but it should not hurt.

A small flexible catheter (tubing) is left in your back for the numbing medicine to travel into your epidural space. You will begin feeling numb in your stomach area, but not in your arms or legs. You will still feel touch, pressure and movement.

A team approach is a patient-centered approach aimed at quality of care. It means coordination and communication between all of the people involved in your care, such as surgical, anesthesia, and nursing staff, from the time your surgery is scheduled to the time you leave the hospital.

You can check on our website under the protocols tab. If a specific surgery is not listed there, then we have not yet implemented an Enhanced Recovery pathway for that particular procedure.

You can check on our website under the resources tab. Additionally, the American Society of Enhanced Recovery at http://aserhq.org/ is an excellent resource.

On the morning of your surgery!