Enhanced Recovery After Surgery: Opioid Sparing Strategies After Discharge: A Review

Comment on ‘Impact of analgesic techniques on early quality of recovery after prostatectomy: A 3‐arm, randomized trial’ by Beilstein and colleagues

“…morphine in 24 h (Doleman et al, 2021). Because of this design limitation, an issue that cannot be answered by this study is whether three analgesic techniques have resulted in different post-operative opioid-sparing effects, an important outcome endpoint of the Enhanced Recovery After Surgery protocols (Rajput et al, 2022).…”

Authors' reply to the comment by Shan et al.

“…It remains, for example, unclear, if and why the use of rescue analgesics seems to be higher in POD 1 in the TAP group (p = 0.008), despite the global test being insignificant. In addition, our study does not contain any data about opioid consumption after hospital discharge, so the issue raised by Rajput et al cannot be addressed based on our data (Rajput et al, 2022).…”

Acute Perioperative Pain Management of the Orthopaedic Patient

“…Rigid protocols may lead to the undertreatment of acute pain and the development of persistent postoperative pain. In addition to the focus on reducing postoperative discharge opioid prescriptions, there is an urgent need for research to substantiate the benefits of nonopioid medications following discharge (Rajput et al, 2022). Healthcare organizations need to proactively provide multidisciplinary care that focuses on patient safety.…”

“…Education regarding the ERAS protocol is essential so patients understand what to expect and how the various components impact the management of their pain and their recovery (Lam et al, 2021; Pearsall et al, 2015). Attempts to discharge patients with little to no opioids after orthopaedic surgical procedures that are commonly associated with the development of chronic pain can increase the risk of undertreated pain, especially in certain populations, including those with opioid tolerance or chronic pain (Rajput et al, 2022).…”