Managing moderate or severe postoperative pain, which affects 75% of patients in the United States, remains a challenge for physicians. With the effect and fallout of the opioid crisis, physicians are seeking alternatives to managing their patients’ pain. A recent literature review explored the current evidence for an alternative, Enhanced Recovery After Surgery (ERAS), in reducing risk caused by opioid use after surgery. Conclusions were published in the Clinical Journal of Pain.
In their analysis, the researchers searched for articles published between 2002 and 2009 that contained the keywords “postoperative pain,” “ERAS,” and “opioid crisis.” ERAS treatment includes preoperative, intraoperative, and postoperative nonopioid interventions. The researchers identified a trend of ERAS methods that aims to limit opioid use in the intraoperative and postoperative period by substituting nonopioid medications or nonpharmacologic solutions.
Use of alternative analgesic solutions in surgery resulted in the reduction of opioid use, sometimes replacing the need altogether. Multimodal opioid-free analgesia has been shown to be particularly effective in reducing opioid use. As part of ERAS treatment, opioid-free analgesia can be used to lessen the amount of opioids prescribed for pain, as well as help patents and caregivers with postoperative management.
Despite these insights, there is no confirmed evidence of ERAS programs having an effect on the opioid crisis at large. Future studies could aim to specifically to understand the effect of ERAS on chronic opioid use after discharge, allowing for longitudinal analysis of results.
Echeverria-Villalobos M, Stoicea N, Todeschini AB, et al. Enhanced Recovery After Surgery (ERAS): a perspective review of postoperative pain management under ERAS pathways and its role on opioid crisis in the United States. Clin J Pain. 2020;36(3):219-226.