Enhanced Recovery After Surgery: Effects on Narcotic Usage in a Community Hospital
Craig Hawkins, *Lynne Pinkham, *Melissa Streeter, *Aaron Koch
MId Coast Hospital, Brunswick, ME
Objective: The opioid epidemic is alarming. The overuse of narcotic prescriptions has been contributory. We chose to examine the narcotic needs of our patients prior to the initiation of the Enhanced Recovery After Surgery (ERAS) protocol and after its implementation.
Setting: Community Hospital
Design: Retrospective study of consecutive patients Pre/post ERAS implementation.
Patients: During 2018, 319 patients underwent hysterectomy(130), total joint replacement( 140), and colectomy( 49). Incorporating an integrated/ interdisciplinary team with standardized protocols for patient centered care with respect to preoperative patient education, intraoperative fluid management, and multimodal perioperative pain management, we measured utilization of preoperative medication, Tap blocks, pain medication in PACU, timing of oral pain medication post operatively, ileus, length of stay, pain medication used post operatively.
Results:
| Hysterectomy | Pre ERAS | Post ERAS |
| Same day discharge | 45% | 98% |
| Length of stay phase 2 recovery | 375 min | 160 min |
| Opiate use in Post Anesthesia Care Unit --PACU | 100% | 80% |
| Opiate use in Ambulatory Care Unit--ACU | 70% | 32% |
| Opiate use at home | 40% for 1.25 days | |
| Colectomy | Pre ERAS | Post ERAS |
| Preop oral pain meds | 0% | 98% |
| Tap Block | 48% | 82% |
| Opiates in PACU | 100% | 51% |
| Oral Pain meds | Post op day 0 16% | Post op day 0- 29% |
| Ileus | 30% | 8% |
| Total Joints | Pre ERAS | Post ERAS |
| Average morphine equivalents in PACU | 22 | 3 |
| Average total morphine equivalents | 144 | 67 |
| Average morphine equivalents /day | 42 | 23 |
| Length of Stay | 3.53 | 2.96 |
Conclusions:We observed a dramatic reduction in narcotic needs post operatively ( 20 - 87 % decrease) in Post Anesthesia Care Unit, Greater than 50 % reduction in narcotics in Ambulatory Care Unit, earlier transition to oral pain meds after colectomy, and approximately 50 % reduction in narcotics after joint replacement
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