Patients undergoing complex anorectal surgery frequently experience moderate to severe pain lasting 7–14 days. This study evaluated a structured, patient-centered enhanced recovery after surgery (ERAS) analgesic protocol for improving pain management in this setting. In this single-center randomized controlled trial, 216 inpatients scheduled for complex anorectal surgery under general anesthesia were randomized (1:1) to the ERAS Protocol Group (anesthesiologist-led ERAS protocol featuring timely intravenous potent opioids for NRS≥4 and consistent pain management until discharge) or the Conventional Care Group (surgeon's traditional pain management). Participants were followed for up to 21 days. The primary outcome was time to full recovery (cessation of analgesics and resumption of preoperative activities). Secondary outcomes included total opioid consumption, pain trajectory, rescue analgesic use, time to ambulation, return of defecation, hospital stay, patient satisfaction, adverse events, and anesthesia-related costs. The ERAS Protocol Group had a significantly shorter time to full recovery (8.0 ± 3.3 vs. 9.9 ± 5.3 days, p= 0.002) and a 20% lower total opioid consumption (36.2 mg vs. 45.4 mg OME, p= 0.005). Opioid use was also lower on postoperative days 1, 4, 5, 8, 10, and 11. The ERAS group had a shorter hospital stay ( p= 0.025) and higher patient satisfaction ( p< 0.001). After propensity-score matching for baseline covariates, differences in recovery time, opioid use, and hospital stay remained significant ( p< 0.05). An ERAS-based analgesic protocol significantly reduced pain, decreased opioid use, shortened hospital stay, and improved satisfaction in patients undergoing complex anorectal surgery.
Wang et al. (Wed,) studied this question.