10 • S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E • M
A R C H 2 0 2 1
E
nhanced Recovery
After Surgery
(ERAS) protocols
involve standard-
ized care pathways
that limit post-op pain with mini-
mal use of opioids. Patients who
enter the pathways often experi-
ence less discomfort, require lim-
ited narcotics and are able to
move through the surgical experi-
ence faster, comfortably and with
fewer side effects. That sounds
good on paper, but how does it
play out in practice?
"There are so many success
stories," says Brooke Chidgey,
MD, an associate professor of
anesthesiology and a pain man-
agement specialist at University of
North Carolina School of
Medicine in Chapel Hill. "I remem-
ber the positive impact ERAS pro-
tocols had on a patient who
underwent a complex procedure
to remove cancerous growths
from his pancreas."
The patient was instructed to
drink a carbohydrate supplement
two hours before surgery and
arrived hydrated, which made starting the IV
easier. In pre-op, he received an epidural and was
given acetaminophen, pregabalin and celecoxib
to preemptively reduce tissue inflammation and
post-op pain.
During surgery, Dr. Chidgey closely monitored
the patient's fluid levels and managed his pain
without the use of opioids. A day after the proce-
dure, the patient experienced little pain and was
able to ambulate. "His ability to get up and moving
soon after such a significant procedure helped to
prevent blood clots and pneumonia," says Dr.
Chidgey. "Not having to administer IV opioids to
manage pain levels also helped his intestines
respond quickly, which is important after a big
abdominal procedure."
Surgery causes physiological stress, and the body
responds to the physical trauma by trying to protect
itself and working to heal, notes Dr. Chidgey.
"These responses release stress hormones and
inflammatory mediators that can cause swelling,
nerve irritation and pain," she says. "If we can blunt
Dan Cook | Editor-in-Chief
Teaming Up to Improve Post-op Pain Control
Multimodal analgesia delivered by a multidisciplinary team
provides preemptive relief from the physical trauma of surgery.
ANALGESIC APPROACH Preparing multimodal medication cocktails to attack pain in various ways is a key aspect of
enhanced recovery protocols.
Lynda
Schoppe
