부산대학교 도서관

BACKGROUND:: Enhanced Recovery After Surgery (ERAS) protocols have known benefits in the inpatient setting, but little is known about their impact in the subsequent outpatient setting. Upon discharge, multimodal analgesia has been discontinued, nerve blocks and pain pumps have worn off, and patients enter a substantially different physical environment, potentially resulting in a rebound effect. The objective of this study was to investigate the effect of ERAS protocol implementation on outpatient opioid use and recovery. METHODS:: Patients who underwent abdominally based microsurgical breast reconstruction before and after ERAS implementation were retrospectively reviewed. Ohio state law mandates that no more than 7 days of opioids may be prescribed at a time, with the details of all prescriptions recorded in a statewide reporting system, from which opioid utilization was determined. RESULTS:: A total of 105 patients met inclusion criteria, of which 46 (44%) were in the pre-ERAS group and 59 (56%) were in the ERAS group. Total outpatient Morphine Milligram Equivalents utilized in the ERAS group was less than the pre-ERAS group (337.5 versus 668.8, respectively; p=0.016). This difference was specifically significant at postoperative week 1 (p=0.044), with gradual convergence over subsequent weeks. Although opioid use was significantly less in the ERAS group, pain scores in the ERAS group were comparable to the pre-ERAS group. CONCLUSIONS:: The benefits of ERAS protocols appear to extend into the outpatient setting, further supporting their use to facilitate recovery, and highlighting their potential role in helping to address the prescription opioid abuse problem.