Enhanced recovery protocol for transoral robotic surgery demonstrates improved analgesia and narcotic use reduction

• Published in: American journal of otolaryngology Vol. 41; no. 6; p. 102649
• Main Authors: Ganti, Ashwin, Eggerstedt, Michael, Grudzinski, Kevin, Ramirez, Emily A., Vaughan, Deborah, Revenaugh, Peter C., Stenson, Kerstin, Al-Khudari, Samer
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2020; Elsevier Limited
• Subjects: Aged; Analgesia; Analgesics; Cohort Studies; Drug Utilization - statistics & numerical data; Enhanced Recovery After Surgery; ERAS; Female; Head and neck; Head and Neck Neoplasms - surgery; Hospitals; Humans; Intensive care; Male; Middle Aged; Morphine; Narcotics; Narcotics - administration & dosage; Opioid; Opioids; Ostomy; Otolaryngology; Pain; Pain management; Pain Measurement - methods; Pain perception; Pain, Postoperative - diagnosis; Pain, Postoperative - drug therapy; Pain, Postoperative - prevention & control; Patients; Prescriptions - statistics & numerical data; Recovery; Recovery (Medical); Retrospective Studies; Robotic surgery; Robotic Surgical Procedures - methods; Statistical analysis; Surgery; TORS; Trans-oral robotic surgery; Treatment Outcome; Trans-oral robotic surgery; Head and neck; Opioid; Enhanced recovery after surgery; TORS; ERAS
• ISSN: 0196-0709; 1532-818X
• DOI: 10.1016/j.amjoto.2020.102649

No study has evaluated the impact of the Enhanced Recovery After Surgery (ERAS) protocol on opioid usage among patients undergoing transoral robotic surgery (TORS).
In this retrospective study, patients undergoing TORS were enrolled in an ERAS protocol and compared to control patients. Primary outcome measures included postoperative mean morphine equivalent dose (MED), Defense and Veterans Pain Rating Scale (DVPRS) pain scores, and opioid prescriptions on discharge.
The mean MED administered postoperatively was lower in the ERAS group (17.6 mg) than in the control group (65.0 mg) (p < .001). Average postoperative DVPRS scores were 2.9 in the ERAS group vs. 4.2 in the control group (p = .042). Fewer patients in the ERAS group received opioid prescriptions on discharge (31.6%) than controls (96.2%) (p < .001).
The TORS ERAS protocol is associated with reduced postoperative opioid usage, lower pain scores, and reduced opioid requirements on discharge.