Impact of enhanced recovery after surgery (ERAS) protocol on postoperative pain control in chronic narcotic users

AbstractPain control is an integral part of Enhanced Recovery after Surgery (ERAS) protocols for colorectal surgery. While opioid therapy remains the mainstay of therapy for postsurgical pain, opioids have undesired side effects including delayed recovery of bowel function, respiratory depression, and postoperative nausea and vomiting. A variety of nonopioid systemic medical therapies as well as regional and neuraxial techniques have been described as improving pain control while reducing opioid use. Multimodal and preemptive analgesia as part of an ERAS protocol facilitates early mobility and early return of bowel function and decreases postoperative morbidity. In this review, we examine several multimodal therapies and their impact on postoperative analgesia, opioid use, and recovery for patients undergoing colorectal surgery.

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Multidisciplinary Cooperation Alleviates Postoperative Pain after Elective Craniotomies: A Prospective Randomized Controlled Study of Neurosurgical Enhanced Recovery After Surgery (ERAS) program

10.21203/rs.2.20215/v1 ◽

2020 ◽

Author(s):

Liang Qu ◽

Yuan Wang ◽

Bolin Liu ◽

Haitao Zhang ◽

Zhengmin Li ◽

...

Keyword(s):

Postoperative Pain ◽

Pain Score ◽

Rating Scale ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Conventional Care ◽

Controlled Study ◽

Control Group ◽

Postoperative Pain Score ◽

Eras Protocol

Abstract Objective: To prospectively evaluate the efficacy of neurosurgical enhanced recovery after surgery (ERAS) protocol on the management of postoperative pain after elective craniotomies. Methods: This randomised controlled trial was conducted in the neurosurgical center of Tangdu Hospital (Fourth Military Medical University, Xi’an, China). A total of 129 patients undergoing craniotomies between October 2016 and July 2017 were enrolled in a randomized clinical trial comparing ERAS protocol and conventional care. The primary outcome was the postoperative pain score assessed by a verbal numerical rating scale (NRS). Results: Patients in the ERAS group had a significant reduction in postoperative pain score on POD 1 compared to patients in the control group (mean NRS 3.12 vs. 4.44, OR 0.0968, 95% CI 0.3299 to 2.317, p = 0.010). More patients (n = 44, 68.8%) in the ERAS group experienced mild pain (NRS: 1 to 3) on POD1 compared with patients (n = 23, 35.4%) in the control group (p < 0.05). A significant reduction in pain score was observed on POD 2 and POD 3 in the ERAS group compared with that in the control group (POD2: mean NRS 2.85 vs. 4.32, OR 0.2628, 95% CI 0.5619 to 2.379, p=0.002. POD3: mean NRS 2.32 vs. 4.03, OR 0.1468, 95% CI 0.9537 to 2.458, p < 0.001, respectively). In addition, the median postoperative length of hospital stay was significantly decreased with the incorporation of ERAS protocol compared to the controls (ERAS: 4 days, control: 7 days, P<0.001). Conclusion: Implementation of the neurosurgical ERAS protocol for elective craniotomy patients have significant benefits in alleviating postoperative pain and enhancing recovery after surgery compared to the conventional care. Further evaluation of this protocol in larger, multi-center studies is warranted.

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Enhanced Recovery After Surgery Multi-Modality Pain Regimen Performs Similar to PRN Narcotics on Outcomes and Pain Control After Cardiac Surgery: A Quality Improvement Project

10.22541/au.164044431.18363624/v1 ◽

2021 ◽

Author(s):

David Blitzer ◽

Chad T. Blackshear ◽

Jameika Stuckey ◽

Leslie Kruse ◽

Lawrence L. Creswell ◽

...

Keyword(s):

Cardiac Surgery ◽

Quality Improvement ◽

Pain Management ◽

Pain Control ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Quality Improvement Project ◽

Improvement Project ◽

Patient Reported ◽

Eras Protocol

Background: While enhanced recovery after surgery (ERAS) pathways have been successfully applied for cardiac surgery, there has been limited research directly comparing ERAS protocols to ad hoc narcotic use after surgery. We hypothesized that a standardized ERAS protocol would provide similar pain management and psycho-emotional outcomes while decreasing the use of opioids in the hospital and after discharge. Methods: As part of a 7-month quality improvement project, cardiac surgery patients on a fast tracked to extubate pathway were assigned PRN narcotic pain management for 3 months (n=49). After a 1-month ERAS protocol optimization period, a separate group of patients were given the ERAS protocol (n=34). Clinical outcomes were gathered, and participants completed a quality of recovery survey that allowed for the assessment of pain and symptom control at 4 time-points post-surgery. Results: Among 83 participants, 66% were male and the mean age was 53 years. There were no differences in patient characteristics between PRN and ERAS groups (all p>0.244). There were no differences between ERAS and PRN groups for surgery characteristics (all p>0.060), inpatient outcomes (all p>0.658), or after-discharge outcomes (all p>0.397). Furthermore, across all time-point comparisons, there were no supported differences in patient-reported outcome and pain control between the ERAS and PRN narcotic groups (all p>0.075). Conclusions: An ERAS protocol demonstrated similar patient outcomes and pain control to traditional opioid use for postoperative cardiac surgery patients. Further research is recommended to further confirm the results of this study.

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Enhanced Recovery After Surgery Protocol with Ultrasound-Guided Regional Blocks in Outpatient Plastic Surgery Patients Leads to Decreased Opioid Prescriptions and Consumption

Aesthetic Surgery Journal ◽

10.1093/asj/sjab137 ◽

2021 ◽

Author(s):

David M Straughan ◽

John T Lindsey ◽

Michelle McCarthy ◽

Davey Legendre ◽

John T Lindsey

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Plastic Surgery ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Ultrasound Guided ◽

Pain Scores ◽

Average Pain ◽

Eras Protocol ◽

Regional Anesthetic

Abstract Background Opioids are a mainstay of pain management. To limit the use of opioids, enhanced recovery after surgery (ERAS) protocols implement multimodal approaches to treat postoperative pain. Objective This paper aims to be the first to assess the efficacy of an ERAS protocol inclusive of ultrasound-guided, surgeon-led regional blocks for outpatient plastic surgery patients. Methods A retrospective review of patients undergoing outpatient plastic surgery on an ERAS protocol was performed. These patients were compared to a well-matched group not on an ERAS protocol (pre-ERAS). Endpoints included the amounts of opioid, anti-nausea, and antispasmodic medication prescribed. ERAS patients were given a postoperative questionnaire to assess both pain levels (0-10) and opioid consumption. ERAS patients anticipated to have higher levels of pain had ultrasound-guided anesthetic blocks. Results There were 157 patients in the pre-ERAS group and 202 patients in the ERAS group. Patients in the pre-ERAS group were prescribed more opioids (332.3 vs. 100.3 morphine milligram equivalents (MME)/patient; p < 0.001), anti-nausea (664 vs. 16.3mg of promethazine/patient; p < 0.001), and antispasmodic (401.3 vs. 31.2mg of cyclobenzaprine/patient; p < 0.001) medication. Patients on the ERAS protocol consumed an average total of 22.7 MME/patient post-operatively. Average pain scores in this group peaked at 5.32 on POD1 and then decreased significantly daily. Conclusions Implementation of an ERAS protocol for outpatient plastic surgery patients with utilization of ultrasound-guided regional anesthetic blocks is feasible and efficacious. The ability to significantly decrease prescribed opioids in this unique patient population is noteworthy.

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An Enhanced Recovery After Surgery (ERAS) Protocol for Ambulatory Anorectal Surgery Reduced Postoperative Pain and Unplanned Returns to Care After Discharge

World Journal of Surgery ◽

10.1007/s00268-017-4414-8 ◽

2018 ◽

Vol 42 (7) ◽

pp. 1929-1938 ◽

Cited By ~ 13

Author(s):

Aaron B. Parrish ◽

Sean M. O’Neill ◽

Steven R. Crain ◽

Tara A. Russell ◽

Deepak K. Sonthalia ◽

...

Keyword(s):

Postoperative Pain ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Anorectal Surgery ◽

Eras Protocol

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Transdermal Postoperative Pain Control Device Approved

Clinical Psychiatry News ◽

10.1016/s0270-6644(06)71906-3 ◽

2006 ◽

Vol 34 (11) ◽

pp. 46

Author(s):

ELIZABETH MECHCATIE

Keyword(s):

Postoperative Pain ◽

Pain Control ◽

Control Device ◽

Postoperative Pain Control

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Written Prescription for Over-the-Counter Nonopioid Pain Medications Does Not Increase the Likelihood of Use after Ambulatory Hand and Upper Extremity Surgery

Journal of Hand and Microsurgery ◽

10.1055/s-0040-1715917 ◽

2020 ◽

Author(s):

Daniel J. Lynch ◽

James S. Lin ◽

Kanu S. Goyal

Keyword(s):

Postoperative Pain ◽

Soft Tissue ◽

Upper Extremity ◽

Pain Control ◽

Control Program ◽

Postoperative Pain Control ◽

Over The Counter ◽

Unequal Variance ◽

Pain Medications ◽

Medication Consumption

Abstract Introduction This study looked to determine how providing written prescriptions of nonopioids affected postoperative pain medication usage and pain control. Materials and Methods Patients undergoing hand and upper-extremity surgery (n = 244) were recruited after the implementation of a postoperative pain control program encouraging nonopioids before opioids. Patients were grouped based on procedure type: bone (n = 66) or soft tissue (n = 178). Patients reported postoperative medication consumption and pain control scores. Two-tailed t-tests assuming unequal variance were performed to look for differences in postoperative pain control and medication consumption between those who were and were not given written prescriptions for nonopioids. Results For both soft tissue and bone procedure patients, a written prescription did not significantly affect patients’ postoperative pain control or medication consumption. Regardless of receiving a written prescription, patients who underwent soft tissue procedures consumed significantly more daily nonopioids than opioids. Conclusion Receiving written prescriptions for nonopioids may not have a significant effect on postoperative pain control or medication consumption. Patients undergoing soft tissue hand and upper extremity procedures may be more likely to consume more daily nonopioids than opioids postoperatively compared to bone procedure patients regardless of whether they receive a written prescription for nonopioids.

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