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Impact of an Enhanced Recovery After Surgery protocol on post Cesarean section opiate consumption and patient’s satisfaction with pain management
Abstract Number: SAT-08
Abstract Type: Original Research
Background: Enhanced recovery after surgery (ERAS) protocols aim at improving patient outcomes and reducing variability in care delivery. In gynecologic surgery, implementation of an ERAS protocol has proven to hasten patient recovery improve patient satisfaction(1). One of the mainstays of ERAS protocols is multimodal analgesia with avoidance of opioid use. In this single institution prospective observational quality improvement study we assessed the impact of an ERAS protocol for cesarean delivery on postoperative opioid use.
Methods: Patients undergoing elective Cesarean Section at the University of Virginia were enrolled in an ERAS protocol pathway. Patients in the ERAS protocol were encouraged to drink clear liquids up to 2 hours prior to induction of anesthesia. Spinal anesthesia was achieved with 1.6-2.0 mL of 0.75% Bupivicaine, 20 mcg of Fentanyl and 100-200 mcg of preservative free Morphine. Post-operatively, pain was managed using scheduled Ketorolac 30mg and Acetaminophen 975mg with opiates as rescue pain medication only. Patients in the non-ERAS pathway received standard preoperative and intraoperative care and received Oxycodone with acetaminophen and naproxen sodium for post-operative pain.
Results: To date, 54 patients have been enrolled in the ERAS recovery pathway. Patients in a non-ERAS pathway were matched to patients in the ERAS pathway for age, parity and number of surgeries. Patients enrolled in the ERAS protocol used less postoperative opioids than those in the non-ERAS pathway [36.2 mg MSO4 vs. 18.1 mg MgSO4, p = 0.0002]. Pain scores were similar in both groups. Patient satisfaction with pain management also improved. Secondary data included and recapitulated in the attached table.
Conclusion: In this preliminary analysis of our institutional ERAS for Cesarean section protocol, we found that patients who received the ERAS protocol used less post-operative opioid than matched controls despite similar pain scores. This observation sheds light on the potential role that a more standardized intra and post-operative pain regimen may have not only on hastened recovery but in the reduction of post-operative opiate consumption in cesarian delivery patients.
1. Modesitt SC, Sarosiek BM, Trowbridge ER, Redick DL, Shah PM, Thiele RH, Tiouririne M, Hedrick TL. Enhanced Recovery Implementation in Major Gynecologic Surgeries. Obstet Gynecol 2016; 128:457-66.
2. Aluri S, Wrench IJ. Enhanced Recovery from obstetric surgery: a UK survey of practice. International Journal of Obstetric Anesthesia 2014; 157-160.