Major Surgey Patients Without Opioids Have Shorter Hospital Stays: Research

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Surgeons at an Ohio hospital have developed a treatment protocol that they say sends people home after operations without any opioids to manage their pain, leading to shorter hospital stays.

“Over 75 percent of our elective colorectal patients underwent surgery without requiring narcotic analgesics postoperatively, including after discharge,” said lead author Sophia A. Horattas, MD, of Cleveland Clinic Akron (Ohio) General Hospital. “During this time period our patient satisfaction scores improved as well as patients’ perceptions of pain control.”
Opioids are the basis of pain control for patients undergoing major surgery, while addiction and unused pills for some patients have been identified as a member of the opioid outbreak.

The researchers presented their findings at the American College of Surgeons Clinical Congress 2018.

The protocol used by the team, Improved Healing Surgery (ERAS), pre-procedure pain management, preventive pain management, non-opioid use of general anesthesia, modified blocks of abdominal nerves, and postoperative non-narcotic analgesics.

All eight general surgeons at the Cleveland Clinic agreed to the protocol in 2016, and the study investigators evaluated the results of 155 patients who underwent elective (non-emergency) colon operations following resection by ERAS protocol.

Overall, 83% (128) of the patients did not require narcotic drugs after their operations. Among those who did, the use of opioids prior to procedures was an indication that they would then need opioids to manage pain; Nine of these 15 patients (56 percent) did. Of the 140 patients who did not use opioids prior to surgery, 85% (119) did not need narcotics.

The researchers found that patients with narcotic pain management often spent more time in the hospital after the operations; The average for the non-narcotic group was 2.7 days versus 2.3 days.
An important element of the protocol is the discussion of pre-patient patient education; this includes consultation with the surgeon and the nursing care coordinator. ”Patients received training materials related to ERAS protocol and their expectations, shorter stay duration, avoidance of narcotic pain medication, early operation of the operation on the same day, and close follow-up by the care team. Horattas said. . Patient education played a major role in protocol compliance, and patient satisfaction increased as it avoided long-term fasting, improved pain control without the side effects of narcotic analgesia, and early discharge from home. “

Surgeons at Cleveland Clinic Akron General has accepted ERAS for other main abdominal operations, such as bariatric procedures, gynecological and genital / urinary system procedures, and liver and gall bladder operations.

Horattas said other institutions could mimic a similar ERAS protocol by identifying key staff in other hospital departments. Cleveland Clinic Akron General’s representatives from surgery, anesthesia, pharmacy and nursing departments came together to discuss the goals and resources of ERAS.

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