Enhanced Recovery After Surgery Program Leads to Less Opioid Use After Colorectal Cancer Surgery

A program on enhanced recovery after surgery (ERAS) resulted in patients who underwent colorectal surgery using half as many opioids compared with patients who underwent surgery prior to implementation of the ERAS program, according to a study presented at the annual meeting of the American Society of Anesthesiologists (Anesthesiology 2019) in Orlando, Florida.

Researchers compared the use of opioids in 181 consecutive patients undergoing colorectal surgery who underwent the ERAS program and compared their opioid use with that of 66 patients treated prior to the ERAS program. The ERAS program standardized patient pain education and multimodal analgesia, though use of opioids was neither standardized nor limited by anesthesia or surgery providers.

The use of opioids decreased in all patients on consecutive days following surgery. The group that underwent the ERAS program experienced a greater decrease in opioid use during all time intervals. The differences, however, were only statistically significant during the intraoperative period, with 45% less opioids; postoperative day 0, with 44% less opioids; and postoperative day 3, with 42% less opioids (P <.05 for all timepoints).

Not surprisingly, the proportion of patients in the ERAS group who received the nonopioid analgesics acetaminophen, gabapentin, ketamine, and ketorolac, was higher compared with the pre-ERAS group. Furthermore, postanesthesia patient-reported pain scores in the ERAS group decreased significantly, suggesting the ERAS program better informs patients on what levels of pain to anticipate following surgery.

Reference

Larson B, McDavid M, Burandt D, Issa H, Tadros R, Soto R. Analysis of opioid use following implementation of a colorectal enhanced recovery after surgery program. Anesthesiology 2019; October 19-23, 2019; Orlando, FL. Abstract A1089.