Enhanced Recovery after Surgery Protocol to Improve Racial and Ethnic Disparities in Postcesarean Pain Management

Area of Science:

• Obstetrics and Gynecology
• Anesthesiology
• Health Services Research

Background:

• Postcesarean pain management presents challenges, with existing disparities affecting certain racial and ethnic groups.
• Traditional pain management often relies on patient-requested analgesia, potentially leading to inadequate pain control and higher opioid consumption.

Purpose of the Study:

• To evaluate the effectiveness of an enhanced recovery after surgery (ERAS) protocol in managing postcesarean pain.
• To determine if the ERAS protocol can mitigate racial and ethnic disparities in pain management outcomes.

Main Methods:

• A retrospective cohort study compared outcomes before and after implementing an ERAS protocol for scheduled cesarean deliveries.
• The ERAS protocol involved scheduled preoperative and postoperative analgesics (acetaminophen, celecoxib, NSAIDs) and limited as-needed oral oxycodone, eliminating patient-controlled analgesia.
• Opioid use (in morphine milliequivalents) and Visual Analog Scale (VAS) pain scores were primary outcomes, with secondary analysis by race.

Main Results:

• Post-ERAS implementation significantly reduced total opioid use within 48 hours (40.8 vs. 8.6 MME) and lowered VAS pain scores on postoperative days 1 and 2 (p < 0.001).
• Prior to ERAS, significant racial disparities in pain scores were observed, with non-Hispanic Black patients reporting higher pain.
• Following ERAS implementation, postoperative pain score differences between racial groups were no longer significant.

Conclusions:

• A standardized ERAS protocol effectively decreases opioid consumption and improves pain control after cesarean delivery.
• The ERAS protocol shows potential in reducing existing racial and ethnic disparities in postpartum pain management.
• Standardized care protocols may help mitigate implicit bias and ensure more equitable pain management for all patients.