Enhanced Recovery after Surgery and Acute Postoperative Pain Management

Eleftheria Kalogera, Sean C. Dowdy

Research output: Contribution to journalArticle

Abstract

Enhanced recovery pathways were first developed in colorectal surgery and have since been adapted to other surgical subspecialties including gynecologic surgery. Mounting evidence has shown that the adoption of a standardized perioperative pathway based on evidence-based literature reduces length of hospital stay, reduces cost, reduces opioid requirements with stable to improved pain scores, and accelerates return to normal function as measured by validated patient reported outcomes measurements. The many elements of enhanced recovery may be distilled into 3 concepts: (1) optimizing nutrition before and after surgery, recognizing that nutritional status directly impacts healing; (2) opioid-sparing analgesia, considering the current American prescription opioid crisis and the importance of pain control to regaining functional recovery; and (3) maintenance of euvolemia before, during, and after surgery. Evidence supporting enhanced recovery is presented with reference to international guidelines which were formed based on systematic reviews. Change management and the use of auditing are discussed to assure that patients derive the greatest improvement in surgical outcomes from implementation of an enhanced recovery pathway.

Original languageEnglish (US)
Pages (from-to)656-665
Number of pages10
JournalClinical Obstetrics and Gynecology
Volume62
Issue number4
DOIs
StatePublished - Dec 1 2019

Fingerprint

Acute Pain
Pain Management
Postoperative Pain
Opioid Analgesics
Length of Stay
Pain
Colorectal Surgery
Gynecologic Surgical Procedures
Nutritional Status
Analgesia
Prescriptions
Maintenance
Guidelines
Costs and Cost Analysis

Keywords

  • enhanced recovery after surgery
  • euvolemia
  • opioid use

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Enhanced Recovery after Surgery and Acute Postoperative Pain Management. / Kalogera, Eleftheria; Dowdy, Sean C.

In: Clinical Obstetrics and Gynecology, Vol. 62, No. 4, 01.12.2019, p. 656-665.

Research output: Contribution to journalArticle

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