Impact of Enhanced Recovery After Surgery and Opioid-Free Anesthesia on Opioid Prescriptions at Discharge From the Hospital: A Historical-Prospective Study

Brandal, Delara; Keller, Michelle S.; Lee, Carol; Grogan, Tristan; Fujimoto, Yohei; Gricourt, Yann; Yamada, Takashige; Rahman, Siamak; Hofer, Ira; Kazanjian, Kevork; Sack, Jonathan; Mahajan, Aman; Lin, Anne

doi:10.1213/ane.0000000000002510

Cited by 182 publications

(129 citation statements)

References 27 publications

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“…Finally, the ERAS cohort had a significantly lower percentage (21.7%) of patients discharged on narcotics versus the control group (90.3%). Brandal et al looked at opioid prescribing practices following ERAS protocols in colorectal surgery . They found that patients utilized less narcotics in the hospital setting but there was no impact on opioid prescribing practices.…”

Section: Discussionmentioning

confidence: 99%

Enhanced recovery after surgery in head and neck surgery: Reduced opioid use and length of stay

et al. 2019

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Objectives: Enhanced recovery after surgery (ERAS) protocols were first developed in colorectal surgery and sought to standardize patient care. There have been several studies in the head and neck surgical literature looking at outcomes after ERAS protocol, but no studies focusing on narcotic use and length of stay. This study aimed to evaluate narcotic usage and length of stay, in addition to several other outcomes, following the implementation of an ERAS protocol.Methods: A head and neck-specific ERAS protocol was implemented at this tertiary care center beginning July 2017. A retrospective cohort study was performed comparing this cohort to that of a retrospective control group. Outcomes included mean morphine equivalent dose, mean pain score, and percentage of patients prescribed narcotics on discharge. Secondary outcomes included ICU and total length of stay.Results: The mean morphine equivalent dose (MED) administered within 72 hours postoperatively was significantly lower in the ERAS group (17.5 AE 46.0 mg vs. 82.7 AE 116.1 mg, P < .001). Average postoperative pain scores in the first 72 hours were lower in the ERAS group (2.6 AE 1.8 vs. 3.6 AE 1.9; P < .001). The average length of stay was shorter for ERAS patients (7.8 AE 4.8 vs. 9.7 AE 4.7 days, P = .008); however, there was no significant difference in ICU length of stay.Conclusion: Following implementation of an ERAS protocol, patients undergoing head and neck surgery had decreased narcotic use in the immediate postoperative period and at discharge, while also demonstrating improved postoperative analgesia.

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Section: Discussionmentioning

confidence: 99%

Enhanced recovery after surgery in head and neck surgery: Reduced opioid use and length of stay

et al. 2019

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“…A colorectal ERP intervention which included epidural analgesia resulted in an increase in the use of opioid-free anesthesia and multimodal analgesia but did not decrease discharge opioid prescriptions 27. It is well recognized that opioid over-prescription occurs regularly after surgery among almost all surgical specialties and opioids are not regularly prescribed in a patient-specific manner to postoperative patients28–30 and up to 71% of these opioid pills go unused 30.…”

Section: Discussionmentioning

confidence: 99%

Role of regional anesthesia and analgesia in the opioid epidemic

Lee

Kumar

et al. 2019

Reg Anesth Pain Med

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“…Recent pediatric data show that 4.8% of opioid-naïve individuals undergoing surgery are at risk of long-term opioid use postoperatively, with colectomy patients being at the highest risk 32. Data also show that despite ERPs leading to lower inpatient opioid consumption, the majority of colorectal surgery patients will be discharged with an opioid prescription 33. By using an ERP, we were able to discharge these patients without an opioid prescription with only one patient (1/50, 2.0%) in the unmatched ERP cohort returning for pain control issues.…”

Section: Discussionmentioning

confidence: 99%

Implementation of an enhanced recovery program in pediatric laparoscopic colorectal patients does not worsen analgesia despite reduced perioperative opioids: a retrospective, matched, non-inferiority study

Edney

Lam

Raval

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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Background and objectivesEnhanced recovery protocols (ERPs) decrease length of stay and postoperative morbidity, but it is important that these benefits do not come at a cost of sacrificing proper perioperative analgesia. In this retrospective, matched cohort study, we evaluated postoperative pain intensity in pediatric patients who underwent laparoscopic colorectal surgeries before and after ERP implementation.MethodsPatients in each cohort were randomly matched based on age, diagnosis, American Society of Anesthesiologists classification, and surgical procedure. The primary outcome was average daily postoperative pain score, while the secondary outcomes included postoperative hospital length of stay, complication rate, and 30-day readmissions. Since our hypothesis was non-inferior analgesia in the postprotocol cohort, a non-inferiority study design was used.ResultsAfter matching, 36 pairs of preprotocol and postprotocol patients were evaluated. ERP patients had non-inferior recovery room pain scores (difference 0 (−1.19, 0) points, 95% CI −0.22 to 0.26 points, p valuenon-inferiority <0.001) and 4-day postoperative pain scores (difference −0.3±1.9 points, 95% CI −0.82 to 0.48 points, p valuenon-inferiority <0.001) while receiving less postoperative opioids (difference −0.15 [−0.21, –0.05] intravenous morphine equivalents/kg/day, p<0.001). ERP patients also had reduced postoperative hospital stays (difference −1.5 [−4.5, 0] days, p<0.001) and 30-day readmissions (2.8% vs 27.8%, p=0.008).ConclusionsImplementation of our ERP for pediatric laparoscopic colorectal patients was associated with less perioperative opioids without worsening postoperative pain scores. In addition, patients who received the protocol had faster return of bowel function, shorter postoperative hospital stays, and a lower rate of 30-day hospital readmissions. In pediatric laparoscopic colorectal patients, the incorporation of an ERP was associated with a pronounced decrease in perioperative morbidity without sacrificing postoperative analgesia.

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Impact of Enhanced Recovery After Surgery and Opioid-Free Anesthesia on Opioid Prescriptions at Discharge From the Hospital: A Historical-Prospective Study

Cited by 182 publications

References 27 publications

Enhanced recovery after surgery in head and neck surgery: Reduced opioid use and length of stay

Enhanced recovery after surgery in head and neck surgery: Reduced opioid use and length of stay

Role of regional anesthesia and analgesia in the opioid epidemic

Implementation of an enhanced recovery program in pediatric laparoscopic colorectal patients does not worsen analgesia despite reduced perioperative opioids: a retrospective, matched, non-inferiority study

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