Reduction of Postoperative Opioid Use After Elective Spine and Peripheral Nerve Surgery Using an Enhanced Recovery...

Area of Science:

• Neurosurgery
• Surgical Outcomes
• Pain Management

Background:

• Enhanced Recovery After Surgery (ERAS) pathways are established for elective spinal procedures.
• Long-term outcomes of ERAS in elective neurosurgery require further investigation.
• This study evaluates an 18-month experience with an ERAS pathway in elective spinal surgery.

Purpose of the Study:

• To assess the effectiveness of an ERAS pathway in elective spinal surgery.
• To evaluate the impact of ERAS on postoperative opioid consumption.
• To analyze secondary outcomes including patient mobility, satisfaction, and length of stay.

Main Methods:

• A historical cohort (149 patients) served as controls.
• 1,141 patients were prospectively enrolled in an ERAS protocol.
• Primary outcome: opioid use at one month postoperation; secondary outcomes: pain scores, satisfaction, catheter use, mobilization, length of stay, complications.

Main Results:

• ERAS significantly reduced opioid use at one, three, and six months postoperation (P < 0.001).
• Patient-controlled analgesia (PCA) use was nearly eliminated in the ERAS group (P < 0.001).
• ERAS patients mobilized faster on postoperative day 0 (P < 0.001) and had a decreased length of stay (3.4 vs. 3.9 days, P = 0.020).

Conclusions:

• ERAS protocols are feasible and effective for elective spine and peripheral nerve procedures.
• Standardized ERAS care decreases opioid usage and eliminates PCA use.
• ERAS protocols facilitate faster patient mobilization and reduce hospital length of stay.