Enhanced Recovery After Surgery

  • Winter 2017

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According to the U.S. Department of Health & Human Services, 2.1 million people in 2015 misused prescription opioids for the first time. Alternative pain methods, such as those implemented at Brookings Health System, are helping to reduce the number of opioids prescribed to patients and fight the opioid epidemic. 

Enhanced Recovery After Surgery (ERAS) is a shift throughout the United States in reducing opioid use after surgical care. Brookings Health System’s anesthesia team has implemented ERAS to provide pain relief to surgical patients instead of opioids. 

“Our goal is to reduce surgical complications and improve outcomes and patient satisfaction throughout the patient stay,” said Anesthesia Director Brian Kvamme. “With ERAS, patients recover faster, have a shorter hospital stay and have fewer post-surgery complications.”

Research shows that ERAS result in reduced care costs and improved patient satisfaction and outcomes. According to the ERAS Society, ERAS reduce postoperative complications by up to 50 percent. A study in the Journal of the American Medical Association found ERAS reduced patient stays from 6.7 days to 3.7 days. In addition, narcotic opioid use during hospital stays dropped from 63 percent to 15 percent of patients. 

Historically, surgical patients would receive a large amount of opioids post-surgery to help control pain for both inpatient and outpatient procedures. 

“Patients would receive an IV of patient-controlled morphine and they’d be lying in their bed half-awake for a few days,” said Kvamme. “That limits their ability to be involved in their care.”

While patients who were prescribed opioids may not feel any pain, they also would be less alert, less able to communicate, and less able to get up and move. What’s more, they’d also endure side effects, such as nausea, vomiting and constipation, and be at risk for developing a dependence on opioids. 

With ERAS, nurse anesthetists perform regional anesthesia when possible and use a variety of non-opioid pain relievers such as acetaminophen, ibuprofen, nerve pain medication and others to control pain post-surgery. 

Care providers also focus on helping patients to maintain their energy levels before, during and after surgery so they can recover more quickly. Patients are encouraged to eat a light meal up to six hours before surgery and to drink a carbohydrate beverage, such as orange juice or milk, two hours before surgery. They are also encouraged to stay hydrated and are not prohibited from water intake after midnight. After surgery, patients are given nutrition right away and are encouraged to move and walk around. 

The ERAS pain control methods implemented at Brookings Health System result in patients taking fewer pain medications and using little to no IV opioids during their stay. 

To learn more about the quality of health care at Brookings Health System, please visit www.brookingshealth.org/Quality