Key result
An enhanced recovery after surgery (ERAS) protocol showed a trend toward reduced 72-hour postoperative opioid use compared to historical controls (75.8 mg vs 105.4 mg oral morphine equivalents; P=0.09).
Why the study?
Evidence supports enhanced recovery after surgery protocols, but minimal data exist regarding their use in cardiac surgery patients.
Does an ERAS protocol containing acetaminophen, gabapentin, and methocarbamol reduce postoperative opioid use in adults after cardiac surgery?
Cohort
Does an ERAS protocol containing acetaminophen, gabapentin, and methocarbamol reduce postoperative opioid use in adults after cardiac surgery?
Absolute Event Rate: 75.8% vs 105.4%
p-value: p=.09
An ERAS protocol containing acetaminophen, gabapentin, and methocarbamol shows a trend toward reduced postoperative opioid use and significantly lowers opioid-related complications in cardiac surgery patients.
May support ERAS evaluation to curb post-cardiac surgery opioids; leaves open confirmation in randomized trials.
Background: Enhanced recovery after surgery (ERAS) protocols are perioperative care pathways designed to achieve early recovery after procedures. ERAS protocols have shown shortened recovery time, and lower opioid utilization and postoperative complication rates. Evidence to support the use of ERAS protocols is robust, however, minimal data exists in cardiac surgery patients. Methods: This observational cohort compared adults receiving post-operative care after coronary artery bypass or valve procedures who received an ERAS protocol containing acetaminophen, gabapentin, and methocarbamol to historical controls. The primary outcome of this study was postoperative opioid use during the first 72-hours following cardiac surgery. Secondary outcomes included length of stay, average pain scores 72-hours postoperatively, and incidence of opioid-related complications. Results: Total cumulative 72-hour post-operative opioid consumption showed a trend toward reduction in opioid use in patients who received the ERAS protocol vs the historic control group [75.8 mg vs 105.4 mg oral morphine equivalents (P = .09)]. Median postoperative lengths of stay and pain scores were similar between groups. Opioid related complications including constipation and respiratory depression occurred more frequently in the control group compared to the ERAS group [47.7% vs 60.5% ( P < .05) and 57.1% vs 62.7% ( P < .05) respectively]. Conclusions: Use of an ERAS protocol shows a promising trend toward less postoperative opioid use in cardiac surgery patients. Lower rates of opioid-related adverse events, including constipation and respiratory depression, were observed in the ERAS protocol group. This study indicates that ERAS protocols have a potential role for cardiac surgery patients postoperatively.
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Bills et al. (2022) conducted a cohort in Cardiac surgery. Enhanced recovery after surgery (ERAS) protocol containing acetaminophen, gabapentin, and methocarbamol vs. Historical controls was evaluated on Postoperative opioid use during the first 72-hours following cardiac surgery (oral morphine equivalents) (p=.09). An enhanced recovery after surgery (ERAS) protocol showed a trend toward reduced 72-hour postoperative opioid use compared to historical controls (75.8 mg vs 105.4 mg oral morphine equivalents; P=0.09).
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