doctors performing surgery

ERAS & Alternatives to Opiate Drugs

Posted on 09/07/17 by Allied Anesthesia


By Dr. Peter Sawras

Last month, I brought up the issue of the U.S. opiate drug crisis and the need for alternatives to opiate drugs. Drugs like morphine are important during recovery from major surgery, but other methods of pain management exist.

Enhanced recovery after surgery (ERAS) is a protocol first developed to optimize the care of patients undergoing a colectomy, a surgery to remove a part of the large intestine. The hospital stay of these patients was reduced from five–ten days to an average of just two days. If you are scheduled to have surgery that involves an incision in your abdomen, such as liver, stomach, intestine and uterus, an anesthesiologist who utilizes any component of ERAS is putting you on the fast track to recovery.

Using non-opioid pain medications is a key intervention of ERAS. Pain pills, such as Celebrex, Tylenol and Neurontin, can be administered in the preoperative area before surgery begins. This is often termed “multimodal analgesia” since these medications work in different ways to manage pain. If an intravenous formulation is more appropriate, IV acetaminophen or IV ketorolac is also available.

A physician anesthesiologist can decide which of these medications may be safely used for your procedure. These medications all help reduce the amount of opiate pain medications needed, and they may decrease the side effects of medications like morphine. Nausea, vomiting, constipation, dizziness and hallucinations are all side effects that multimodal analgesia can help reduce.

Patients often say, “Tylenol doesn’t work for me.” Remember, these medications work together to reduce the total amount of opioids used for your recovery. Let’s imagine that you wake up from surgery with a pain score of 7 out of 10, and you were only given morphine. If Tylenol were added preoperatively, perhaps your score would only be 5.

Maybe you were also given Celebrex before surgery, so your pain score is only 4. This is how multimodal analgesia works. Since discharge from the recovery room requires pain control between a score of 4 to 6 (based on each individual’s pain tolerance), you are now on the fast track to recovery. Join me next time for nerve blocks and regional anesthesia techniques for an even faster recovery!


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