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Enhanced Recovery After Surgery: Opioid Sparing Strategies After Discharge: A Review

  • Regenerative Pain and Medicine/Interventional Pain and Medicine (EC Bradley, Section Editors)
  • Published:
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Abstract

Purpose of Review

Many surgical subspecialties have developed enhanced recovery after surgery (ERAS) protocols that focus on multimodal analgesia to limit opioid use during a hospital stay and improve patient recovery. Unfortunately, ERAS protocols do not extend to post-discharge patient care, and opioids continue to be over prescribed. The primary reason seems to be a lack of good quality research evaluating extended use of a multimodal analgesic approach. This review was undertaken to evaluate available evidence for non-opioid analgesics in the postoperative period after discharge, utilizing Pubmed, Scopus, and Google Scholar.

Recent Findings

Several studies have explored strategies to reduce the overprescribing of opioids after surgery without worsening postoperative pain scores or complications. However, these studies do not necessarily reflect on situations where an ultra-restrictive protocol may fail, leading to breakthrough pain. Ultra-restrictive opioid protocols, therefore, could risk undertreatment of acute pain and the development of persistent post-surgical pain, highlighting the need for a review of non-opioid strategies.

Summary

Our findings show that little research has been conducted on the efficacy of non-opioid therapies post-discharge including acetaminophen, NSAIDs, gabapentin, duloxetine, venlafaxine, tizanidine, valium, and oral ketamine. Further studies are warranted to more precisely evaluate the utility of these agents, specifically for their side effect profile and efficacy in improving pain-control and function while limiting opioid use.

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Authors and Affiliations

  1. Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA

    Kanishka Rajput, Sukhman Shergill, Robert M. Chow & Nalini Vadivelu

  2. Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, LA, USA

    Alan David Kaye

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  1. Kanishka Rajput
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  2. Sukhman Shergill
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Correspondence to Kanishka Rajput.

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Rajput, K., Shergill, S., Chow, R.M. et al. Enhanced Recovery After Surgery: Opioid Sparing Strategies After Discharge: A Review. Curr Pain Headache Rep 26, 93–102 (2022). https://doi.org/10.1007/s11916-022-01009-x

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