Perioperative quality and service is an increasing area of focus for hospitals. Enhanced recovery after surgery (ERAS) protocols are important processes that many hospitals are implementing to help improve perioperative care—with significant benefits for both healthcare facilities and patients. For some hospitals, multimodal approaches to pain management are becoming the cornerstone of ERAS programs.
 
ERAS protocols incorporate preoperative counseling, optimization of nutrition, early mobilization, and standardized analgesic and anesthetic regimens.¹ Research shows that the use of ERAS protocols can lead to a 35 percent decrease in healthcare costs.² A structured perioperative program can help streamline patient care and minimize staff member errors. Additionally, patient turnover times may be reduced thanks to earlier patient discharge rates, allowing hospitals to serve more patients overall.³
 
When implemented successfully, ERAS protocols have been associated with an average decrease of 1.56 days in length of hospital stay for patients—without a concurrent rise in readmissions or mortality.⁴ ERAS has also been linked to a reduction in complications and an increase in patient satisfaction.²
 
The optimal management of postoperative pain is an important component of ERAS that can play a major role in how well patients recover after surgery. Inadequate pain management can prolong time to recovery milestones, such as mobilization and ambulation—lengthening hospital stays and leading to readmissions.⁵ Effective pain management can improve clinical outcomes and patient quality of life, while avoiding clinical complications, thereby saving healthcare resources.⁵
 
Traditionally, postoperative pain has primarily been treated using opioids. Use of opioids as the “mainstay” of pain management can result in psychological addiction and adverse effects, such as nausea and vomiting, sedation, dizziness, constipation and respiratory depression—all of which may delay patient discharge.⁶ Multimodal pain management solutions are associated with fewer opioid-related side effects, along with fewer interruptions to physical therapy.⁷ Many patients may not be aware that there are non-addictive alternatives to opioids, but one study found that 72 percent of patients would choose non-opioid pain medication for postoperative pain management if given the option.⁵
 
To improve outcomes, some hospitals are enhancing their ERAS protocols with multimodal approaches to pain management, which use a combination of regional nerve blocks, periarticular injections, neuraxial anesthesia, and postoperative oral and intravenous medications to provide better results for patients.⁷ As part of a recent update to its existing ERAS protocol, for example, Virginia Mason Medical Center implemented multimodal pain management solutions such as continuous peripheral nerve blocks and postoperative oral analgesics. The updated ERAS protocol resulted in significant improvements in acute clinical outcomes including reduced opioid consumption, enhanced physical therapy participation with reduced pain, and a decrease in hospital length of stay (56.1 hours compared to 76.6 hours) for patients without an increase in readmission. Patients from the updated ERAS pathway were more likely to be discharged home independently without the need for skilled nursing or home health services. These factors may result in a corresponding decrease in hospital costs.⁸
 
By employing ERAS protocols that emphasize multimodal methods for pain management and opioid reduction, healthcare facilities may decrease healthcare costs and improve patient outcomes.
 
References
¹ Melnyk M, Casey RG, Black P, Koupparis AJ. Enhanced recovery after surgery (ERAS) protocols: time to change practice? Can Urol Assoc J 2011;5(5):342-343.
² Thiele RH, et al. Standardization of care: impact of an enhanced recovery protocol on length of stay, complications, and direct costs after colorectal surgery. J Am Coll Surg 2015;220(5):986.
³ Nanavati AJ, Prabhakar S. Enhanced recovery after surgery: if you are not implementing it, why not? Practical Gastroenterology. 2016;151:46-56.
⁴ Wind J, et al. Systematic review of enhanced recovery programmes in colonic surgery. Brit J of Surg 2006;93(7):800-9.
⁵ Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesthesia & Analgesia. August 2003;97(2):534-40.
⁶ Benyamin R, et al. Opioid complications and side effects. Pain Physician 2008;11:105-120.
⁷ Parvizi J, Bloomfield MR. Multimodal pain management in orthopedics: implications for joint arthroplasty surgery. Orthopedics. 2013;36(2 Suppl):7-14.
⁸ Auyong DB, et al. Reduced length of hospitalization in primary total knee arthroplasty patients using an updated enhanced recovery after orthopedic surgery (ERAS) pathway. J Arthoplasty 2015;30(10):1705-1709.