Effect of Opioid-Sparing Multimodal Anesthesia Within an Enhanced Recovery After Surgery (ERAS) Protocol Pathway on Postoperative Recovery in Gynecologic Oncologic Surgery: A Randomized Clinical Study

Background. Major gynecologic oncological procedures are associated with moderate to severe postoperative pain and significant morbidity. Opioids remain a cornerstone of postoperative analgesia but are frequently linked with adverse effects that may delay recovery. Enhanced Recovery After Surgery (ERAS) protocols emphasize multimodal analgesia strategies aimed at minimizing opioid use while improving recovery outcomes. The aim of this study was to evaluate whether an opioid-sparing multimodal anesthesia protocol within an ERAS pathway improves postoperative outcomes in patients undergoing gynecologic oncologic surgery. Methods. This randomized clinical study included 101 women undergoing major gynecologic oncological procedures. Fifty-one patients were allocated to an ERAS protocol incorporating multimodal anesthesia and opioid-sparing strategies, while 50 patients received conventional perioperative care. Standardized anesthesia management was applied in both groups, with the ERAS group receiving additional multimodal interventions including perioperative magnesium, structured antiemetic prophylaxis, early oral intake, and early transition to oral analgesia. Pain scores, rescue analgesic use, postoperative complications, time to oral intake, gastrointestinal recovery, and discontinuation of intravenous therapy were analyzed. Results. Patients managed under the ERAS protocol demonstrated significantly lower postoperative pain scores at all measured time points compared with controls (p < 0.001). Rescue analgesic requirements were significantly reduced in the ERAS group (p < 0.001). Early oral feeding within six hours occurred significantly more frequently in the ERAS group than in the control group (p < 0.001). Gastrointestinal recovery and early discontinuation of intravenous therapy were also significantly improved in the ERAS group (p < 0.001). Additionally, ERAS patients exhibited lower incidences of vomiting, sedation, and somnolence postoperatively (p = 0.01, p = 0.01, and p = 0.001, respectively). Conclusions. Implementation of an opioid-sparing multimodal anesthesia strategy within an ERAS pathway significantly improves postoperative recovery in gynecologic oncologic surgery. The protocol reduces opioid-related adverse effects, enhances gastrointestinal recovery, and supports earlier mobilization and oral intake. These findings reinforce the role of multimodal anesthesia as a key component of ERAS programs in oncological surgery.