Study: ERAS protocol reduces opioid use after cardiac surgery

Editor's Note

Implementing a multimodal analgesia-based enhanced recovery after surgery (ERAS) protocol significantly reduced both intraoperative opioid administration and postoperative opioid prescriptions in cardiac surgery patients, according to a January 5 report in Anesthesiology News.

The findings were presented at the 2024 International Anesthesia Research Society meeting by Montefiore-Einstein Center for Heart and Vascular Care in New York City. As detailed in the article, the organization introduced its ERAS protocol in 2020, addressing preoperative, intraoperative, and postoperative pain management. Preoperatively, patients were given medications such as pregabalin and acetaminophen while being prepared with realistic expectations. Intraoperative measures included ketamine and dexmedetomidine infusions, limited fentanyl use, and regional anesthesia techniques such as serratus anterior blocks and ropivacaine infiltration. Postoperatively, the protocol prioritized early extubation and multimodal pain management with limited opioid reliance.

As detailed in the article, the researchers analyzed data from 2,338 cardiac surgery patients between 2016 and 2021, researchers found that prior to ERAS implementation, opioid prescribing rates were stable. However, within the first month of ERAS, the probability of receiving an opioid prescription dropped by 1.7% (P<0.001), followed by a sustained 0.1% monthly decline (P=0.004). Median postoperative intravenous opioid administration decreased by 23%, from 37.5 to 28.7 morphine milligram equivalents (P<0.001). Notably, these changes were not mandated—rather, the protocol’s collaborative approach influenced providers to prescribe fewer opioids at discharge.

Noting that 10% of cardiac surgery patients become persistent opioid users, experts said engaging the entire perioperative team in ERAS protocols can shift prescribing habits, eliminating unnecessary “just in case” opioid scripts, Anesthesiology News reports.