The effectiveness of ERAS guidelines in reducing postoperative pain

Poorly controlled acute postsurgical pain can promote chronic opioid use and misuse long after the initial surgical procedure. Enhanced recovery after surgery (ERAS) guidelines have shown promise in reducing opioid exposure and minimizing opioid-related side effects.

The aims of this evidence-based practice (EBP) project were to assess the ERAS literature to guide postoperative pain management practice change at an adult colorectal surgical unit, evaluate the practice change outcomes, and disseminate the findings.

A Population, Intervention, Comparison, Outcome, and Time (PICOT) question was established to guide an ERAS literature search. Found articles were critically appraised using the FULD Critical Appraisal Tool. Following the critical appraisal, the steps of EBP were utilized to implement an ERAS guideline for adult colorectal surgical patients in a 281-bed medical center. Outcomes of the practice change were evaluated by comparing multimodal analgesic, regional anesthesia, and opioid pain medication use before and after guideline implementation.

Five articles were critically appraised for guideline development. After implementation, data demonstrated an increase in the use of multimodal analgesics and regional anesthesia and a decrease in the use of opioid pain medication. These findings were disseminated through multiple venues within the hospital, including a presentation to the stakeholders.

Evidence-based strategies to reduce postoperative pain are achievable while reducing perioperative opioid consumption. Engagement of key stakeholders and timely rollout of EBP changes are important for successful implementation. ERAS guidelines with a multimodal analgesia pathway are an effective way to reduce postoperative pain and perioperative opioid consumption.