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ASA: Enhanced Recovery Program Cuts Opioid Use After Colorectal Surgery

TUESDAY, Oct. 22, 2019 — Colorectal surgery patients treated as part of an enhanced recovery after surgery (ERAS) program have less pain and use nearly half as many opioids as pre-ERAS patients, according to a study presented at the annual meeting of the American Society of Anesthesiologists, held from Oct. 19 to 23 in Orlando, Florida.

Bradley Larson, M.D., from Beaumont Health in Royal Oak, Michigan, and colleagues compared the opioid use of colorectal surgical patients before and after implementation of an ERAS program. The analysis included 181 consecutive patients identified from the colorectal ERAS registry and 66 pre-ERAS patients. The ERAS program standardized multimodal analgesia use and patient pain education, but opioid use was not standardized or limited by either anesthesia or surgery providers.

The researchers found that opiate use decreased in both groups on consecutive postsurgical days, with the ERAS group experiencing a greater decline in opiate use during all time intervals. This difference was only statistically significant during the intraoperative period (45 percent fewer opioids), postoperative day 0 (44 percent fewer opioids), and postoperative day 3 (42 percent fewer opioids). In the ERAS group, the number of patients who were given nonopiate adjuncts (ketorolac, acetaminophen, gabapentin, and ketamine) was higher versus the pre-ERAS group. Pain scores assessed in the postanesthesia care unit significantly decreased in the ERAS group.

“Through ERAS, patients are educated regarding the appropriate level of pain to anticipate after surgery and are more willing to accept that some form of postoperative pain is normal and to be expected,” Larson said in a statement. “Therefore, they are less likely to request additional medication to attempt to fully alleviate their pain, which leads to decreased opioid consumption.”

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Posted: October 2019


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