Role of modified enhanced recovery after surgery (mERAS) in awake craniotomy performed under monitored anesthesia care (MAC); a single center retrospective study

Background This study aims to explore the safety and efficacy of awake craniotomy procedures under monitored anesthesia care (MAC), focusing on the impact of modified Enhanced Recovery after Surgery (ERAS) protocols on patient outcomes. Methods Patients undergoing elective awake craniotomy between 2017 and 2022 were divided into two groups: those receiving the ERAS protocol after 2020 and a control group of pre-2020 patients. Factors examined included demographics, intraoperative awakening time, procedure durations, pain management, hospital stay length, complications, discharge disposition, and follow-up symptoms. Results From 2017 to 2022, 61 patients underwent awake craniotomy using MAC anesthesia at University Hospitals Cleveland Medical Center, with 23 receiving the ERAS protocol after 2020. Demographics were comparable between the control and ERAS groups. Total awake time, time to wake up, and total procedure time showed no significant differences (P > 0.05). Awake craniotomy was discontinued in 8 cases due to anxiety and pain (mERAS = 1, Control = 7). The mERAS group experienced fewer cases of awake failure, nausea/vomiting, and postoperative cognitive and speech deficits, though these differences were not statistically significant. No significant differences were found in postoperative pain medication consumption, complications, or length of hospital stay (P > 0.05). Conclusions Awake craniotomy under MAC with a modified ERAS protocol is feasible but did not show statistically significant improvements in patient outcomes. Further research with larger sample sizes and multi-center collaboration is necessary to draw more definitive conclusions.