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Multimodal analgesia in Enhanced Recovery After Surgery (ERAS) protocols reduced opioid use in cesarean section patients, according to a retrospective study.

At a New Jersey community teaching hospital, fewer women required opioids after C-section with implementation of ERAS protocols -- including transversus abdominis plane (TAP) blocks and multimodal analgesia -- versus those who received traditional perioperative care (341 vs 1,766, P<0.001), reported Nnamdi Gwacham, DO, of the Saint Barnabas Medical Center in Livingston, and colleagues.

After ERAS pathway implementation, women who underwent a C-section delivery also had a shorter hospital stay than those who received traditional care (2.63 vs 3.91 days, P<0.001), they stated in an abstract in . The research was scheduled to be presented this weekend at the American College for Obstetricians and Gynecologists annual meeting, which was canceled due to the COVID-19 crisis.

They also found that there was a lower average cost for patients in the ERAS pathway compared with the historical cohort ($3,957 vs $4,290, P<0.001).

Gwacham told 番茄社区app that the goal of implementing ERAS protocols was both to reduce inpatient opioid use and duration of hospital stays after C-sections.

"Our cesarean sections [patients] were routinely getting opioids around the clock, and they were routinely going home with a prescription for opioids," Gwacham said. Protocols for enhanced recovery were part of an effort to combat the opioid epidemic.

"We understand that patients need narcotics," Gwacham added. "Our goal was not to do away with them completely; our goal was to reduce the amount that we were giving."

Sarah Osmundson, MD, of Vanderbilt University Medical Center in Nashville, said that the impact of ERAS pathways on reducing opioid use in outpatient settings is a question that remains unanswered.

"What we really want to see is less misuse, and diversion, and long-term opioid problems," Osmundson, who was not involved in the study, told 番茄社区app. "So we hope that reducing inpatient use leads to that, but none of these outcomes really tell us that information."

Gwacham and colleagues compared patients who underwent C-section delivery in an ERAS pathway to a historical cohort that received traditional perioperative care. Patients included in the historical cohort were in the hospital from January to June 2018, and patients included in the ERAS pathway were in the hospital from January 2019 onward.

After implementation of the ERAS pathway, 98% of patients received TAP blocks immediately after surgery, and all patients received scheduled doses of a multimodal analgesia -- a combination of ibuprofen, acetaminophen, and dextromethorphan. If pain was not well controlled with this regimen, patients received narcotics.

Patients in the ERAS pathway also underwent early ambulation, and were allowed to drink clear liquids up to 2 hours prior to surgery, Gwacham said.

There were 2,109 patients in the historical cohort and 1,463 in the ERAS pathway. The two groups had no significant differences in age, race, or BMI.

In addition to a reduced number of patients who required opioids after implementation of enhanced recovery protocols, researchers noted that utilization dropped from 8,082 opioid units to 803 opioid units.

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