Optimization of an Enhanced Recovery After Surgery protocol for opioid-free pain management following robotic thoracic surgery

Get your 7-point golden medal for pain management in video-assisted thoracoscopic surgery

“…The review by Batchelor et al sheds light on a crucial but frequently overlooked problem of conservative chest drain management. Chest drains, a necessary 'evil' of thoracic surgery, can impede respiratory function, ambulation, and oral intake, all of which are essential components of enhanced recovery after thoracic surgery (ERATS) [19 ]. As previously mentioned, regional analgesic techniques may not adequately address visceral pain, necessitating systemic (non)opioid treatment with varying results [5 && ].…”

Commentary: Semper ad meliora: Continuous improvement in enhanced recovery pathways

“…Kodia and colleagues, 8 in their investigation “Optimization of an Enhanced Recovery Protocol for Opioid-Free Pain Management Following Robotic Thoracic Surgery,” detail their institutional results following a change in their ERAS protocol to further decrease opioid use postoperatively. Their updated ERAS protocol involved diluting liposomal bupivacaine with 30 mL of 0.25% bupivacaine instead of normal saline to better mitigate pain in the immediate postoperative setting and potentially decrease the need for intravenous hydromorphone.…”

“…The authors report significantly less opioids were required in the postanesthesia care unit, in the hospital, and after discharge in the optimized ERAS protocol when compared with their original ERAS protocol, without a significant difference in patient-reported pain levels or operative complications. 8 …”

Commentary: Opioid reduction in lung cancer surgery: Important for reasons that may surprise you

“…Kodia and colleagues 6 demonstrate how an iterative approach to Enhanced Recovery Pathways in thoracic surgery can continue to yield meaningful improvements in patient outcomes. Adjustments in the protocol for regional blockade, as well as the change in delivery of oral opioids to “as needed” instead of scheduled, and tramadol instead of oxycodone has resulted in substantially lower in- and out-of hospital opioid use.…”

“…It is also laudable that Kodia and colleagues 6 were able to track outpatient opioid use with Florida state prescription monitoring data. I congratulate both the authors as well as Florida state officials for making this possible.…”