Title:The Impact of Enhanced Recovery after Surgery Protocol Implementation
on Postoperative Pain Management in the Era of Opioid Crisis: The Postchemotherapy
Open RPLND Experience
Volume: 23
Issue: 11
Author(s): Konstantinos Dimitropoulos*, Louis L. Pisters, Christos N. Papandreou, Danai Daliani, Anastasios Karatzas, Argiro Petsiti, Vassilios Tassoudis, Eleni Arnaoutoglou, Panagiotis J. Vlachostergios*Vassilios Tzortzis
Affiliation:
- Department of Urology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, Scotland, United Kingdom
- Academic
Urology Unit, University of Aberdeen, Aberdeen, Scotland, United Kingdom
- Department of Urology, Faculty of Medicine, School of Health Sciences,
University Hospital of Larissa, University of Thessaly, Larissa, Greece
- Department of Medical Oncology, IASO Thessalias Hospital, Larissa, Greece
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY, USA
Keywords:
ERAS, enhanced recovery protocol, retroperitoneal lymph node dissection, RPLND, pain, opioids, cancer patients.
Abstract:
Aim: Enhanced Recovery After Surgery (ERAS) protocols have been proven to optimize
postoperative outcomes; however, misuse of opioid analgesics can still hinder postoperative recovery
due to related side effects and potential complications.
Introduction: To determine if the implementation of ERAS protocol in post-chemotherapy retroperitoneal
lymph node dissection (PC-RPLND) patients could help with reducing postoperative pain and
opioid use.
Methods: A case-control study of consecutive testicular cancer patients with indications for PCRLPND,
who were offered Conventional Post-operative Management (CPM) or ERAS protocol. Outcomes
of interest included Visual Analogue Scale (VAS)-assessed pain level at postoperative days 3,
7, and 30, and Morphine-Equivalent Doses (MEDs)/postoperative day. Intraoperative parameters and
postoperative complications were recorded. Parametric and non-parametric tests were used for statistical
analysis.
Results: In total, 100 opioid-naïve PC-RPLND patients were studied. CPM and ERAS groups (36 and
64 patients, respectively) had similar demographic and baseline clinical characteristics). ERAS group
patients had significantly lower blood loss (p = 0.005), blood transfusion rate (p < 0.001), and duration
of the procedure (p < 0.001). Post-operative complications were comparable between groups.
Nausea and bowel disorders were numerically but not statistically more frequent in the CPM group.
ERAS patients had shorter mean hospital stay (5.3 ± 1.4 vs. 7.4 ± 1.6 days, p < 0.001), lower daily
MEDs (4.73 ± 2.63 vs. 7.04 ± 2.29, p < 0.001), and lower VAS scores on post-operative day 7 (3.89 ±
1.07 vs. 4.67 ± 1.17, p = 0.001). Post-operative pain was similar between groups on post-operative
days 3 and 30.
Conclusion: Systematic implementation of ERAS protocol after PC-RPLND improves pain management,
optimizes patient recovery, and prevents over-prescription of opioid analgesics.
