Physicians at an Ohio hospital have developed a treatment protocol that they claim is effective enough to send patients home after operations without any opioids to manage their pain, leading to shorter hospital stays.  This protocol will also help curtail the nationwide opioid crisis.“Over 75 percent of our elective colorectal patients underwent surgery without requiring narcotic analgesics postoperatively, including after discharge,” said lead author Sophia A. Horattas, MD, of Cleveland Clinic Akron General Hospital. “During this time period, our patient satisfaction scores improved as well as patients’ perceptions of pain control.”The researchers presented their Enhanced Recovery After Surgery (ERAS) at the American College of Surgeons Clinical Congress 2018.  ERAS includes a patient education portion about pain management before surgical procedures, pre-emptive pain management, use of general anesthesia during surgery, modified blocks of the abdominal nerves, and postoperative programmed non-narcotic analgesics.  Eight physicians at Cleveland Clinic Akron General adopted the protocol back in 2016.

Photo by Marcel Scholte on Unsplash

Researchers evaluated outcomes of 155 patients who had colon operations and were administered the ERAS protocol.  Overall, 83 percent of patients did not need narcotic medications after surgery.  And, the researchers found that patients on narcotic pain management after operations typically spent more time in the hospital.A key component of ERAS is providing patient education ahead of time, including meetings scheduled with the surgeon and nursing care coordinator. “Patients received educational materials regarding the ERAS protocol and their expectations were addressed regarding the shorter length of stay, avoidance of narcotic pain medications as able, early ambulation the same day of the operation, and close follow-up by the care team,” Dr. Horattas said. “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.”Physicians at Cleveland Clinic Akron General have since adopted ERAS for bariatric procedures, gynecological and genital or urinary tract procedures, and operations of the liver and gallbladder.  At Cleveland Clinic Akron General, representatives from the departments of surgery, anesthesia, pharmacy and nursing met to discuss the goals of ERAS.The Cleveland Clinic Breast Center also recently rolled out the ERAS protocol in order to limit the use of opioids pre- and post-surgery.  “We are excited about finding new ways to manage pain,” says Stephanie Valente, DO, Director of the Breast Surgery Fellowship Program at Cleveland Clinic. “Surgeons have an obligation to treat their patients’ postoperative pain, but also to follow appropriate prescribing behavior and avoid overprescribing.  If we are effective at managing pain, patients won’t need as much pain medication.”She added, “We will learn whether infiltration of pain medications at the surgical site with longer lasting drugs such as Exparel, in combination with patient education and other multimodal therapies, can effectively and completely control postoperative pain.  The ability to administer pain medicine only at the surgical site will allow a patient to have minimal pain at home and be able to get back to normal activities sooner without the need for opiates.”

Sources:

Major Surgery Patients Without Opioids Have Shorter Hospital Stays: ResearchPostoperative Pain Management without Opioids for Mastectomy and Reconstruction