Implementation of enhanced recovery protocols reduces opioid use in pediatric laparoscopic cholecystectomy surgery

Dantes, Goeto; Keane, Olivia A.; Margol, Matthew; Thompson, Oluwatoyin; Darville, Gregory; Clifton, Matthew S.; Heiss, Kurt F.

doi:10.1007/s00383-022-05195-y

Cited by 4 publications

(1 citation statement)

References 18 publications

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“…As more pediatric ERAS protocol studies exemplify the effectiveness of their practice, their use is becoming more standardized across pediatric surgical subspecialties. 15,[19][20][21] In the craniomaxillofacial surgical space, studies have shown that implementation of ERAS practice can be effective at pain management as well as improve recovery time. 2 More recently, ERAS protocols for cleft lip repair have been proven to reduce opioid use, leading to shortened time to feeding resumption and return to function.…”

Section: Discussionmentioning

confidence: 99%

Opioid Sparing by ERAS Protocol in Cleft Lip and Palate Craniofacial Surgery

Thawanyarat

Waitt

Navarro

et al. 2023

FACE

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Background: Enhanced Recovery After Surgery (ERAS) protocols have been shown to improve both clinical outcomes and cost savings in various perioperative settings. Our study focuses on the effects of ERAS protocol in craniomaxillofacial surgery in a single institution within 2 years leading up to and following implementation. The purpose of this research is to quantify the changes in effective pain management in pediatric patients undergoing craniomaxillofacial procedures before and after our ERAS protocol, which did not include IV acetaminophen. We hypothesize that ERAS protocol, even without IV acetaminophen, will provide effective pain management while decreasing the opioid use4 in the perioperative and postoperative period without associated complications from NSAID therapy. Methods: A retrospective chart review was conducted on 137 pediatric patients that underwent craniofacial surgery between July 1, 2014, and June 30, 2020. Patients were divided into 2 cohorts: Pre-ERAS and Post-ERAS with the implementation of ERAS on July 1, 2017. Results: Post-ERAS cohort showed increased NSAID use in the preoperative and postoperative period for both IV and PO ( P = .006 and P = .0064). Morphine use showed no immediate changes until a year after implementation with a statistically significant reduction ( P = .0051). When stratified by procedure type, IV NSAID (Ketorolac) use increased in Palatoplasty procedures ( P = .0154) while PO NSAID (Ibuprofen) use increased in Cleft Lip Repair ( P = .0224). Conclusion: ERAS protocol implementation can provide benefit for pediatric patients undergoing craniomaxillofacial surgery by decreasing opioid use, even in the absence of IV acetaminophen. Outcomes may potentially be delayed in the immediate post-implementation period. This study can add to the expanding literature for the use of ERAS protocol in craniomaxillofacial surgical settings. Further studies can include analyzing potential barriers to implementation and future complications related to ERAS long term outcomes.

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Section: Discussionmentioning

confidence: 99%

Opioid Sparing by ERAS Protocol in Cleft Lip and Palate Craniofacial Surgery

Thawanyarat

Waitt

Navarro

et al. 2023

FACE

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Where Will Gabapentin’s Bumpy Road Lead us? A Narrative Review of Pediatric Perioperative Gabapentinoids

Li,

2023

Curr Anesthesiol Rep

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Purpose of Review Gabapentinoids, including gabapentin and pregabalin, have been commonly administered in the perioperative period since opioid-sparing effects were found in adults in the early 2000s. This review examines the current evidence for and against the perioperative use of gabapentinoids in children and identifies potential future directions for research. Recent Findings Many factors led to increasing use of gabapentinoids for surgical patients. The national opioid epidemic hastened the move toward the use of multimodal analgesia and early recovery after surgery protocols for both adults and children. However, subsequent adult studies have found less benefit in postoperative pain reduction than once thought, while others have investigated substantial adverse side effects. The most convincing data supporting the use of pediatric perioperative gabapentinoids show reductions in emergence agitation, postoperative nausea and vomiting (PONV), and chronic persistent surgical pain. Summary As adult trials of perioperative gabapentinoids show decreasing benefits in postoperative pain, opioid consumption, and postoperative nausea and vomiting (PONV) amidst increasing concerns of adverse side effects, benefits for children focus more on reduction in emergence agitation, PONV, and chronic postsurgical pain with more research needed to explore optimal dosing regimens and potential adverse side effects.

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Endogenous opiates and behavior: 2022

Bodnar

2023

Peptides

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Implementation of enhanced recovery protocols reduces opioid use in pediatric laparoscopic cholecystectomy surgery

Cited by 4 publications

References 18 publications

Opioid Sparing by ERAS Protocol in Cleft Lip and Palate Craniofacial Surgery

Opioid Sparing by ERAS Protocol in Cleft Lip and Palate Craniofacial Surgery

Where Will Gabapentin’s Bumpy Road Lead us? A Narrative Review of Pediatric Perioperative Gabapentinoids

Endogenous opiates and behavior: 2022

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