Reducing narcotics use for pain after surgery

Enhanced Recovery After Surgery, or ERAS, is being used for heart, colorectal, abdominal, and hip and knee replacement surgeries at Norton Healthcare. It was piloted at Norton Audubon Hospital four years ago and has since been implemented at Norton Healthcare’s other adult-service hospitals.

With ERAS, patients receive non-narcotic analgesics before surgery, decreasing the need for narcotic medication after surgery, which has many side effects in addition to the risk for abuse and addiction.

“The whole idea is to move patients through their surgery and back home so they can resume their normal daily activities as quickly as possible,” said William R. Bradford, M.D., medical director and general surgeon at Norton Audubon Hospital.

“We’re in a crisis with opioids, and surgery is well known as a starting point for patients getting introduced to opioid medications,” Dr. Bradford said. “What we’re learning here is other medications are controlling patients’ pain as well, or better.”

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ERAS also allows patients to drink clear liquids up to two hours before surgery, keeping them hydrated; and patients receive a carbohydrate load several hours before surgery to keep the intestines working.

Developed in England as a way to minimize costs and drug use, ERAS protocols have shown the additional benefit of faster recovery times.

Major intestinal surgery used to mean a seven- to 10-day hospital stay, mainly waiting for the intestines to resume normal function. Heavy use of narcotics slows the intestines’ recovery. With ERAS, the same surgery now often requires only two to four days in the hospital, according to Dr. Bradford.

“I’ve done surgery on patients in their 80s and older through the ERAS program,” Dr. Bradford said. “Right after surgery, they’re sitting up with smiles on their faces, feeling good. Those are things I never thought I’d see.”

With ERAS, patients are expected to be out of bed within 24 hours of surgery. If surgery ends in the afternoon or evening, the goal is to be out of bed the following morning.

Dr. Bradford said ERAS meets patients’ top priority of getting back to their lives as quickly as possible after surgery.

Continuing education on opioid abuse

CME credits are available through online learning at Click on “CME Activities” and then “Online Activities.” In the search field, type in “HB1” to see available learning opportunities about opioids or view here.

Physicians now can access convenient continuing medical education through the monthly “MedChat” podcast. “MedChat” fills a unique professional gap and is structured around a conversation addressing key issues for each topic. “MedChat” episodes last 30 minutes, so you can listen on your way to work, while walking the dog, eating your lunch or another convenient time for you.

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