Penn Medicine ERAS program reduces opioid use in spine surgery patients


Philadelphia-based Penn Medicine developed an Enhanced Recovery After Surgery protocol for spine and peripheral nerve surgery patients to reduce opioid dependency.

The ERAS program was designed to optimize patients' surgical care before, during and after surgery. It included patient education, postoperative medications and recovery plans. Penn Medicine's program centered around coordination among the entire clinical team and included a robust multi-modal pain management protocol.

To evaluate the protocol's effectiveness, the university conducted a prospective study, which included two groups of patients who underwent elective spine or peripheral nerve surgery. The ERAS group comprised 201 patients who underwent surgery between April and June 2017. The control group comprised 74 patients who were treated between September and December 2016.

Penn Medicine published the results in the Journal of Neurosurgery: Spine.

Researchers found that intravenous opioid medications via patient-controlled analgesia was nearly eliminated in the ERAS group. At one-month postoperatively, fewer patients in the ERAS group — 38 percent — were using opioids compared to 53 percent of the control group.

Pain scores were similar in both groups, suggesting PCA was not necessary in this population.

"ERAS protocols engage each aspect of the patient's surgical journey to improve clinical outcomes and optimize a safe recovery," said lead author and principal investigator Zarina Ali, MD. "This novel approach allows a framework for addressing pain management in a responsible and effective manner while dramatically reducing opioid use during and after surgery."

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