New Protocol Eschews Opioids for Postsurgical Pain Management

Study Finds Recipients Also Require Shorter Postprocedure Hospitalization

In a presentation at the American College of Surgeons Clinical Congress 2018, clinicians from Cleveland Clinic Akron General Hospital detailed a treatment protocol that avoids the use of opioids following colorectal surgery and that results in shorter hospital stays. Lead author Sophia Horattas, MD, commented, “Over 75% of our elective colorectal patients underwent surgery without requiring narcotic analgesics postoperatively, including after discharge. During this time period our patient satisfaction scores improved as well as patients' perceptions of pain control.” The conclusions were drawn from a study of 155 patients who underwent elective colon surgery with resection and who received the new protocol, termed Enhanced Recovery After Surgery (ERAS). 83% of the study cohort did not need opioids following their procedure, and this group averaged 2.3 days of hospitalization postsurgery, as compared to 2.7 days for patients who did use opioids following surgery. The protocol has been adopted by all 8 general surgeons at Cleveland Clinic Akron and has been in use since 2016.

The ERAS protocol employs preemptive analgesia including acetaminophen, gabapentin, and celecoxib administered before surgery. During surgery, ketamine and lidocaine are used to maintain analgesia and sedation. Patients also receive a transversus abdominis plane (TAP) nerve block to provide pain management for up to 72 hours following surgery. A critical component of the ERAS protocol is patient engagement and education, according to the presenting authors. Dr. Horattas remarked, “Patient education played a large role in protocol compliance, and patient satisfaction improved as they were able to avoid prolonged fasting, achieve improved pain control without the side effects of narcotic analgesia, and be discharged home earlier.”

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