Neurosurgery 97:936–944, 2025
Implementation of an enhanced recovery after surgery (ERAS) protocol for microvascular decompression in trigeminal neuralgia significantly reduced hospital length of stay, improved postoperative pain scores, and decreased transient hearing alterations compared to conventional care, without increasing complications, according to a retrospective matched cohort study.
• Enhanced Recovery After Surgery (ERAS) protocol was implemented for microvascular decompression (MVD) in trigeminal neuralgia (TN) patients and compared to conventional care in a retrospective matched cohort study.
• ERAS protocol included preoperative counseling, scalp block, small incisions, minimal muscle dissection, total intravenous anesthesia without narcotics, early enteral feeding, and early mobilization.
• 130 patients (65 ERAS, 65 non-ERAS) were analyzed after propensity score matching for key demographics and comorbidities.
• ERAS group had significantly shorter hospital length of stay (1.46 vs 2.95 days, P < .001) and lower postoperative verbal pain scores (1.63 vs 2.48, P = .03) than controls.
• ERAS patients experienced fewer transient postoperative subjective hearing alterations (0 vs 6 cases, P = .03).
• No significant difference in postoperative Barrow Neurological Institute (BNI) pain scores or major complications between groups.
• Subgroup analysis showed ERAS patients discharged at 24 hours had even lower pain scores than controls.
• Study limitations include retrospective design, small sample size, and use of subjective pain scores; larger randomized trials are needed.
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