Penn Medicine: Recovery protocols reduce need for opioids after spinal, peripheral nerve surgery

Penn Medicine: Recovery protocols reduce need for opioids after spinal, peripheral nerve surgery

Researchers have found that following an “after surgery” protocol developed at the University of Pennsylvania School of Medicine, patients did not need opioids for pain management.

Called the “Enhanced Recovery After Surgery,” or ERAS, the protocol is a personalized, safe, and effective pain management plan to help prevent opioid addiction. The protocol engages patients in their own care before, during, and after their hospitalization, and includes patient education, text reminders, nutritional information, early mobilization, and recovery plans. The ERAS protocol also relies on collaboration between patients, anesthesiologists, rehabilitation therapists, nurses, neurosurgeons, and everyone else involved in the patient’s surgical journey.

Starting with pre-operative consultation on everything from nutrition, drug, alcohol and tobacco use cessation, diabetes management to education about the surgery and the surgical wound site, the protocol starts with preparing the patient for what’s to come. During the periop period, the team, along with the patient, focuses on multimodal analgesia, wound care, mobility, and metabolism management. During post-op, the team focuses on communication, wound care management, and post-operative resource management.

Researchers found that when ERAS protocols were used, fewer patients needed pain medications at one, three, and six months after surgery.

“We know from our clinical experience and previous literature that programs like ERAS work, but we didn’t expect the impact on opioid use to be so sizeable,” said senior author Zarina S., Ali, MD, an assistant professor of Neurosurgery at Penn. “The most important outcome from this study is the decrease in opioid use. Furthermore, patients following the ERAS protocol reported less opioid use without higher pain scores. This represents an important advance in the context of the current nationwide opioid epidemic.”

The study looked at a total of 1,141 patients enrolled in the ERAS protocol and compared their results to 149 patients who received standard care. The researchers’ found that only 38.6 percent of ERAS patients needed opioids one month after surgery, compared to 70.5 percent of the control group needing pain medication after a month.

At the three months after surgery benchmark, 36.5 percent of the ERAS patients needed pain medication compared to the 70.9 percent of the control group. And at the six months after surgery point, only 23.6 percent of the ERAS patients needed pain medication, compared to 51.9 percent of the control group.

Additionally, researchers noted that patients in the ERAS group had a significant reduction in the use of patient-controlled analgesia or a pain pump. Only 1.4 percent of ERAS patients used a pain pump, compared to 61.6 percent of the patients in the control group. Additionally, ERAS patients were up and moving more quickly than those in the control group (63.5 percent compared to 20.7 percent, and fewer ERAS patients required post-op catheterization. ERAS patients also had fewer hospital stays – 3.4 days for ERAS patients, compared to 3.9 days for those receiving standard care.

“Previous publications have demonstrated ERAS implementation in neurosurgery practices primarily through minimally invasive spinal surgery, but our neurosurgical practice has been actively applying ERAS principles to elective spine and peripheral nerve surgery since 2017, in coordination with a variety of departments across the health system,” said Tracy M. Flanders, MD, first author and Neurosurgery resident at Penn. “This study captures the exciting benefits of this protocol for minimizing opioid use, decreasing length of stay, and more—without impacting patient satisfaction.”