Eastern Cardiothoracic Surgical Society

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Enhanced Recovery after Surgery Protocol significantly decreases Opioid Use
Rahul Kumar, Tanya Bell, Heather Grillo, Katherine Kuhns, Taras Grosh, Colleen Gaughan, Sunil Singhal, John Kucharczuk, Taine Pechet, Doraid Jarrar.
University of Pennsylvania, Philadelphia, PA, USA.

OBJECTIVE: Thoracic surgery, even when done minimally invasive, causes pain and may contribute to long-term opioid abuse. It has been estimated that up to 15% of patients will become opioid dependent. We hypothesized that initiating an Enhanced Recovery After Surgery (ERAS) protocol will decrease opioid use and improve pain scores.
METHODS: . A protocol was implemented based on published data from other institutions and best practice guidelines.
The ERAS protocol included a preoperative course of Gabapentin, Tylenol, and Oxycodone, followed by an intraoperative course of Ketamine, an intercostal nerve block (liposomal Bupivacaine), and Dexamethasone. The postoperative course included Gabapentin, Tylenol, Ketorolac, Famotidine, and Oxycodone. Initial PACU pain scores, inpatient oral narcotic usage, and discharge narcotic totals were collected over the course of 8 months, and were compared retrospectively to 8 months of historical controls, which involved thoracic epidural analgesia. RESULTS:Our results show that implementation of ERAS resulted in a dramatic improvement in initial PACU pain scores for both video-assisted thoracoscopic surgery (VATS) and thoracotomy procedures compared to historic controls (44% and 74% improvement respectively). We were also able to show a decrease in inpatient oral narcotic usage for both VATS and thoracotomy (56% and 11% decrease respectively), along with a substantial reduction in discharge narcotic totals for both VATS and thoracotomy (87% and 86% reduction respectively) with the ERAS protocol compared to historic controls.
CONCLUSIONS: Ultimately, the implementation of our ERAS protocol is feasible with the participation of multiple stakeholders, decreases postoperative opioid use and improves patient pain scores.


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