American researchers have recently assessed an enhanced recovery after surgery (ERAS) program employed in patients undertaking elective caesarean delivery. The study included 4,689 women from a period 12 months before the program was started, and 4,624 women from the 12 months after ERAS was deployed. Following the program, mean inpatient opioid use was reduced from 10.7 average daily morphine equivalents (95% CI 10.2–11.3) to 5.4 equivalents (95% CI 4.8–5.9). Multimodal analgesia exposure (including use of acetaminophen and neuraxial anaesthesia) increased from 9.7% to 88.8%, with the proportion of time involving acceptable pain scores from patients increasing from 82.1% to 86.4% (P<0.001). The post-ERAS period also saw a decrease in outpatient opioids dispensed at discharge, from 85.9% to 82.2% (P<0.001) and a reduction from 38 to 26 (P<0.001) in the average number of dispensed pills. In addition, there was a decrease in time to first post-surgical ambulation (2.7 hours, [95% CI −3.1 to −2.4]) and first post-surgical solid intake (11.1 hours, [95% CI −11.5 to −10.7]). For length of hospital stay , surgical site infections, hospital readmissions and breastfeeding rates there were no significant differences between the groups in this study. The ERAS program successfully reduced opioid exposure and was not associated with worsened clinical outcomes. The original reference can be accessed here.
Contributed by Australian Medication Safety Services Associate – Isabella Singh