Outcomes of an opioid-free peri-operative protocol for colorectal surgery

Newer ERAS protocols aim to eliminate the use of opioids throughout the peri-operative experience entirely. An opioid-free peri-operative protocol was initiated at a stand-alone cancer center for patients undergoing colorectal surgery. The objective of this study was to determine safety and feasibility of the intra-operative protocol and examine factors associated with the use of opioids for those who underwent the full peri-operative protocol as intended. A single-center retrospective cohort study was conducted. Patients included were those who underwent colorectal surgery using the opioid-free intra-operative protocol. A subset of patients who received the full peri-operative protocol as intended was analyzed. A total of 86 patients were identified who underwent surgery using the opioid-free intra-operative protocol. Of those, 66 also received the full peri-operative ERAS protocol as intended. The median pain score in PACU of those who underwent the intra-operative protocol was 5 (IQR 0,8). Notably, the most common score was 0 (n = 25, 29%). Only 4 patients (4.7%) experienced post-operative nausea and vomiting requiring more than one dose of anti-emetic within 24 h. Of the 66 patients who received the full peri-operative protocol, low pain scores were observed throughout the post-operative period. Median pain scores on each post-operative day (POD) ranged from 2 (POD3) to 4 (PODs 0 and 1). Of the 66 peri-operative protocol patients, only 18 (27.3%) required any opioid throughout their entire course and only 6 (9.1%) required an opioid prescription on discharge. On multivariable analysis, only BMI was independently associated with receipt of opioids (OR = 0.86, p = 0.049) indicating that higher BMI was protective against opioid use. The results indicate that an opioid-free peri-operative experience is safe and feasible for use in colorectal cancer surgery. When implemented correctly it can result in low pain scores and infrequent use of opioids in the post-operative course.