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

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.

scholarly journals Oral Versus Intravenous Acetaminophen within an Enhanced Recovery after Surgery Protocol in Colorectal Surgery

2020 ◽  
Vol 1;23 (1;1) ◽  
pp. 57-64 ◽  
Author(s):  
Joseph H. Marcotte
Keyword(s):  
Pain Management ◽  
Colorectal Surgery ◽  
Postoperative Nausea ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Postoperative Nausea And Vomiting ◽  
Opioid Use ◽  
Patient Controlled Analgesia ◽  
Pain Scores ◽  
Eras Protocol

Background: Multimodal pain management within enhanced recovery after surgery (ERAS) protocols is designed to decrease opioid use, promote mobilization, and decrease postoperative complications. Objectives: To evaluate the role of intravenous (IV) versus oral (PO) acetaminophen within an established ERAS protocol in colorectal surgery. Study Design: This was a retrospective observational study. Setting: This research took place within an established perioperative colorectal surgery protocol. Methods: A total of 91 consecutive elective colorectal resections performed according to an ERAS protocol using only IV acetaminophen (IV group) were compared with 84 consecutive resections performed using one dose of IV acetaminophen followed by subsequent administration of oral acetaminophen (PO group). Our multimodal pain management strategy also included transverse abdominis plane blocks, celecoxib, and ketorolac medications for both groups. Opioid requirements, maximum and average daily pain scores by the Visual Analog Scale, and postoperative outcomes were compared between groups. Results: There were no differences in maximum or average pain scores on postoperative days 0-3 or at time of discharge between IV and PO groups. Compared with the IV acetaminophen only group, the PO group received significantly more perioperative opioids through 72 hours postoperatively (68.8 oral morphine equivalents [OME] IV group vs. 93.7 OME PO group; P < 0.0001), were more likely to require opioid patient-controlled analgesia (8.9% IV group vs. 46.4% PO group; P < 0.0001), and were more likely to experience postoperative nausea and vomiting (33.0% IV group vs. 48.8% PO group; P = 0.0449). Limitations: Significant limitations include the studies’ retrospective nature and that it was performed at a single institution. Conclusions: Restriction of IV acetaminophen within an ERAS protocol in colorectal surgery was associated with increased opioid use, greater need for opioid patient-controlled analgesia, and increased incidence of postoperative nausea and vomiting. IV acetaminophen may be superior to oral acetaminophen in the early postoperative setting. Key words: Perioperative pain management, enhanced recovery after surgery, acetaminophen, multimodal pain control, nonopioid

Benefits of Enhanced Recovery After Surgery in Patients Undergoing Endoscopic Sinus Surgery

2019 ◽  
Vol 34 (2) ◽  
pp. 280-289 ◽  
Author(s):  
Yunbo Gao ◽  
Chengshuo Wang ◽  
Guyan Wang ◽  
Xu Cui ◽  
Guang Yang ◽  
...  
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Adverse Reactions ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Sinus Surgery ◽  
Self Rating ◽  
Pain Scores ◽  
Lower Pain ◽  
Traditional Care ◽  
Eras Protocol

Background Although enhanced recovery after surgery (ERAS) protocols have been widely applied during perioperative periods for different diseases, there are few reports of ERAS in patients undergoing endoscopic sinus surgery (ESS). This study therefore aimed to evaluate the benefits of ERAS protocol compared to traditional care following ESS. Methods A total of 55 patients with chronic rhinosinusitis undergoing ESS were prospectively assigned to 1 of 5 treatment groups; ERAS groups with postoperative intravenous Flubiprofen Axetil or analgesia pump, traditional care with Flubiprofen Axetil or analgesia pump (NERAS groups), or traditional care without postoperative intravenous analgesia group (control). All patients completed the Kolcaba General Comfort Questionnaire, Medical Outcomes Study Sleep Scale, and Self-rating Anxiety Scale at admission and before discharge. Pain scores were recorded at 2, 6, 24, and 48 hours postsurgery and adverse reactions to analgesics were noted. Results Patients in ERAS group demonstrated significantly higher general comfort scores and lower self-rating anxiety scores compared to patients in NERAS and control groups. Compared to control patients, patients in ERAS group reported significantly lower pain scores at 6, 24, and 48 hours. Moreover, pain alleviated from 6 hours postsurgery in ERAS group compared to 48 hours in NERAS group. Patients using opioids experienced more adverse nausea events than patients using only nonsteroidal anti-inflammatory drugs (NSAIDs). Conclusions The use of patient-tailored ERAS programs following ESS may help to attain higher general comfort and to alleviate perioperative anxiety compared with traditional perioperative care. Adequate postoperative analgesia with NSAIDs in ERAS protocol may alleviate pain earlier with fewer adverse reactions.

Enhanced Recovery after Surgery: Benefits for the Fetal Surgery Patient

2021 ◽  
pp. 1-8
Author(s):  
Mario Patino ◽  
Thien-Duy Tran ◽  
Teniola Shittu ◽  
Margaret Owens-Stuberfield ◽  
Marcie Meador ◽  
...  
Keyword(s):  
Magnesium Sulfate ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Oral Intake ◽  
Respiratory Complications ◽  
Traditional Group ◽  
Traditional Management ◽  
Pain Scores ◽  
Oxygen Requirements ◽  
Eras Protocol

<b><i>Background:</i></b> The fetoscopic approach to the prenatal closure of a neural tube defect (NTD) may offer similar advantages to the newborn compared to prenatal open closure of a NTD, with a reduction in maternal risks. Enhanced recovery after surgery (ERAS) protocols have been applied to different surgical procedures with documented advantages. We modified the perioperative care of patients undergoing in utero repair of myelomeningocele with the goal of enhancing the recovery. A retrospective study comparing traditional management to the ERAS protocol was conducted. <b><i>Aims:</i></b> Primary aim was to evaluate the length of stay (LOS). Secondary outcomes included pain scores, time to oral intake, opioid-induced side effects, and respiratory complications. <b><i>Methods:</i></b> Thirty patients who underwent a mid-gestation fetoscopic closure of a NTD were included. Data analyzed include demographics, comorbidities, LOS, anatomical location of the NTD, magnesium sulfate doses and duration of administration, oxygen requirements, duration of the postoperative epidural infusion, duration of surgery and anesthesia, incidence of postoperative nausea and vomiting, respiratory complications, time to oral intake, pain scores, and sedation scores. Differences between the treatment groups were compared using the independent sample <i>t</i>-test or Mann-Whitney Ʋ test. <b><i>Results:</i></b> Of the 30 patients, 10 patients were managed according to the ERAS protocol and 20 patients according to the traditional management (1:2 ratio). The mean gestational age at the time of intervention for the traditional and ERAS groups was 24.9 ± 0.5 weeks and 24.8 ± 0.5 weeks, respectively. Compared to the traditional group, the LOS was reduced in the ERAS group to 112.5 ± 12.6 h (4.7 ± 0.5 days) from 179.7 ± 87.9 h (7.5 ± 3.7 days) (<i>p</i> = 0.012). The time to oral intake was also shorter 502.6 ± 473.4 min versus 1015.6 ± 698.2 min; <i>p</i> = 0.049. Oxygen requirements were prolonged in the traditional group (1843.7 ± 1262.6 min vs. 1051.7 ± 1078.1 min <i>p</i> = 0.052). The total duration of magnesium sulfate was longer for patients in the traditional group (2125.6 ± 727.1 min vs. 1429.5 ± 553.8 min; <i>p</i> = 0.006). No statistically significant difference in pain scores was observed between the groups. <b><i>Conclusions:</i></b> Establishing an ERAS protocol for fetoscopic in utero repair of NTDs approach is feasible with the advantages of decreased postoperative LOS, reduced oxygen requirements, lower duration of magnesium sulfate infusion, and facilitation of earlier oral intake without compromising the pain scores.

scholarly journals Comparative short-term outcomes of enhanced recovery after surgery (ERAS) program and none-ERAS traditional care in elderly patients undergoing lumbar arthrodesis: a retrospective study

2021 ◽  
Author(s):  
Zhong-En Li ◽  
Shi-Bao Lu ◽  
Chao Kong ◽  
Wen-Zhi Sun ◽  
Peng Wang ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Elderly Patients ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Postoperative Recovery ◽  
Demographic Characteristics ◽  
Care Group ◽  
Pain Scores ◽  
Lumbar Arthrodesis ◽  
Traditional Care

Abstract Background: Enhanced recovery after surgery (ERAS) program is an evidence-based improvement over none-ERAS traditional care. The aim of the present study was to analyze the safety, feasibility, and efficacy of an ERAS program in patients over 70 years undergoing lumbar arthrodesis by comparison with none-ERAS traditional care.Methods: During January 2018 to December 2018, patients enrolled received none-ERAS traditional care, while the ERAS program was implemented from January to December 2019. Demographic characteristics, comorbidities, surgical data and postoperative recovery parameters were collected from all patients. Postoperative pain scores were evaluated by visual analog scales (VAS). The clinical outcomes were length of stay (LOS), postoperative complications and postoperative pain scores. Compliance results were also collected.Result: A total of 127 patients were enrolled, including 67 patients in the none-ERAS traditional care group and 60 patients in the ERAS group. The demographic characteristics and comorbidities of the two groups showed no significant differences. The LOS of patients treated with ERAS program (13.6±4.0 days) was significantly less than that of patients treated with none-ERAS traditional care (15.6±3.9 days) (p = 0.034). Complication rate was 8.3% in the ERAS group versus 20.9% in the none-ERAS traditional care group (p = 0.048). VAS (back) in the ERAS group was significantly lower on postoperative day (POD) 1 and POD2. Postoperative recovery parameters were improved in the ERAS group. The overall compliance with the ERAS program was 94%.Conclusions: Based on our results, ERAS program is safer and more effective for elderly patients over 70 undergoing lumbar arthrodesis than none-ERAS traditional care.

Intravenous Acetaminophen for Postoperative Pain Management in Patients Undergoing Living Laparoscopic Living-Donor Nephrectomy

2016 ◽  
Vol 51 (1) ◽  
pp. 21-26 ◽  
Author(s):  
Van Vu ◽  
William L. Baker ◽  
Elizabeth M. Tencza ◽  
Caroline Rochon ◽  
Patricia A. Sheiner ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Living Donor ◽  
Postoperative Pain Management ◽  
Living Donor Nephrectomy ◽  
Pain Scores ◽  
Opioid Administration ◽  
Patient Reported ◽  
Average Pain ◽  
Control Versus

Background: Postoperative pain is a common complication of laparoscopic living-donor nephrectomies (LLDNs). Objective: To determine whether intravenous (IV) acetaminophen administration post-LLDN influenced length of stay (LOS) when used for pain management. Methods: This single-center, retrospective study compared patients undergoing LLDN who had received IV acetaminophen for pain control versus those who did not between June 1, 2011, and November 30, 2015. Patient LOS, 30-day readmissions, frequency of pain assessments, patient-reported pain scores, and opioid administration were assessed. Results: A total of 90 patients were included in the analysis (IV acetaminophen, n = 48; non-IV acetaminophen, n = 42). Patients who did not receive IV acetaminophen were more often older (48.8 ± 12.1 vs 39.3 ± 12.1 years; P = 0.012) and female (71.4% vs 47.9%; P < 0.001). The average LOS was similar between the 2 groups (median = 3.0; interquartile range = [3, 4] vs 3.5 [3, 4]; P = 0.737). The 30-day readmissions were higher in the IV acetaminophen group (16.7%) compared with the group not receiving IV acetaminophen (2.4%; P = 0.033). After the first postoperative day, the frequencies of pain assessments performed were similar among the 2 groups. There was no difference in average pain scores between the groups at any time after LLDN. Conclusions: Patients receiving IV acetaminophen were found to have no improvements in hospital LOS, average pain score, or opioid requirements compared with patients not receiving IV acetaminophen. Patients who received IV acetaminophen were also found to have a higher 30-day readmission rate.

Post-Cesarean Opioid Use after Implementation of Enhanced Recovery after Surgery Protocol

2020 ◽  
Author(s):  
Caitlin A. MacGregor ◽  
Mark Neerhof ◽  
Mary J. Sperling ◽  
David Alspach ◽  
Beth A. Plunkett ◽  
...  
Keyword(s):  
Pain Management ◽  
Pain Score ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Opioid Use ◽  
Trial Of Labor ◽  
Cesarean Deliveries ◽  
Preoperative Diet ◽  
Eras Protocol ◽  
Postoperative Morphine

Objective This study aimed to evaluate whether implementation of an enhanced recovery after surgery (ERAS) protocol is associated with lower maternal opioid use after cesarean delivery (CD). Study Design We performed a pre- and postimplementation (PRE and POST, respectively) study of an ERAS protocol for cesarean deliveries. ERAS is a multimodal, multidisciplinary perioperative approach. The four pillars of our protocol include education, pain management, nutrition, and early ambulation. Patients were counseled by their outpatient providers and given an educational booklet. Pain management included gabapentin and acetaminophen immediately prior to spinal anesthesia. Postoperatively patients received scheduled acetaminophen and ibuprofen. Oxycodone was initiated as needed 24 hours after spinal analgesia. Preoperative diet consisted of clear carbohydrate drink consumed 2 hours prior to scheduled operative time with advancement as tolerated immediately postoperation. Women with a body mass index (BMI) <40 kg/m2 and scheduled CD were eligible for ERAS. PRE patients were randomly selected from repeat cesarean deliveries (RCDs) at a single site from October 2017 to September 2018, BMI <40 kg/m2, without trial of labor. The POST cohort included women who participated in ERAS from October 2018 to June 2019. PRE and POST demographic and clinical characteristics were compared. Primary outcome was total postoperative morphine milligram equivalents (MMEs). Secondary outcomes included length of stay (LOS) and maximum postoperative day 2 (POD2) pain score. Results All women in PRE (n = 70) had RCD compared with 66.2% (49/74) in POST. Median total postoperative MMEs were 140.0 (interquartile range [IQR]: 87.5–182.5) in PRE compared with 0.0 (IQR: 0.0–72.5) in POST (p < 0.001). Median LOS in PRE was 4.02 days (IQR: 3.26–4.27) compared with 2.37 days (IQR: 2.21–3.26) in POST (p < 0.001). Mean maximum POD2 pain score was 5.28 (standard deviation [SD] = 1.86) in PRE compared with 4.67 (SD = 1.63) in POST (p = 0.04). Conclusion ERAS protocol was associated with decreased postoperative opioid use, shorter LOS, and decreased pain after CD. Key Points

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

2018 ◽  
Vol 149 ◽  
pp. 19 ◽  
Author(s):  
H.J. Smith ◽  
T.K.L. Boitano ◽  
T. Rushton ◽  
M.C. Johnston ◽  
C.A. Leath ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Control ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Postoperative Pain Control ◽  
Eras Protocol
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