Enhanced Recovery After Surgery (ERAS)

Abstract

Objectives: The objective of this study was to review the current scientific evidence on the role of Enhanced Recovery After Surgery (ERAS) implementations in reducing postoperative opioid consumption and their potential association with the risk reduction for long-term opioid use, physical opioid dependency, and opioid addiction. Methods: A literature search was conducted using the following medical subject heading keywords: “postoperative pain,” “postoperative pain management,” “multimodal analgesia,” “ERAS,” “Enhanced Recovery,” “opioid-free analgesia,” or “opioid crisis.” Discussion: Identification and management of pre-existing psychosocial factors, comorbid pain entities, and chronic opioid use have a significant impact on the severity of postoperative pain. Different multimodal analgesia approaches have been associated with reduced postoperative pain scores and opioid consumption. Health care providers, patients, and family members should recognize the advantages of opioid-free analgesia techniques in postoperative pain management. As part of ERAS protocols, transitional pain services may consider current therapeutic alternatives for acute and long-term pain management that include minimizing perioperative opioid use and establishing adequate opioid prescription practices.

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

“…The significant risks and costs associated with opioid overuse are now better understood: opioid-related adverse events frequently potentiate complications in postoperative populations and postsurgical opioid prescribing patterns have contributed to the modern U.S. opioid epidemic [6][7][8][9][10][11]. Postoperative opioid prescribing in the U.S. remains alarmingly high and in stark contrast to that of non-U.S. countries, underscoring the need for more widespread adoption of multimodal analgesia and enhanced recovery strategies by American centers [4,[12][13][14].…”

The role of regional analgesia in personalized postoperative pain management

“…In light of the opioid epidemic in North America, there is an even greater need for techniques to reduce perioperative opioid use. Opioid over-prescribing in the perioperative period can lead to prolonged postoperative opioid use and misuse, leading to tolerance, dependence, and opioid-induced hyperalgesia [17,18]. As well as nonopioid analgesics such as ketamine, intravenous lidocaine, and gabapentinoids, regional anesthesia has been shown to reduce intraand postoperative opioid use [18,19].…”

Effects of dexmedetomidine as a perineural adjuvant for femoral nerve block: A systematic review and meta-analysis

“…Various opioid-sparing analgesic approaches, including non-steroidal antiinflammation drugs, intrathecal opioids, peripheral nerve block and multimodal analgesia, have been extensively investigated. By combining a variety of analgesic medications and techniques in order to reduce corresponding adverse effects, multimodal perioperative analgesia has been an indispensable component of Enhanced Recovery After Surgery [38]. FNB, which covers the anteromedial aspect of the knee and hip, is an effective analgesic technique for numerous lower extremity surgeries including knee arthroplasty, knee or hip arthroscopic surgery, and cruciate ligament reconstruction [39,40].…”