The Impact of Enhanced Recovery after Surgery Protocol Implementation on Postoperative Pain Management in the Era of Opioid Crisis: The Postchemotherapy Open RPLND Experience

Konstantinos Dimitropoulos; Louis L Pisters; Christos N Papandreou; Danai Daliani; Anastasios Karatzas; Argiro Petsiti; Vassilios Tassoudis; Eleni Arnaoutoglou; Panagiotis J Vlachostergios; Vassilios Tzortzis

doi:10.2174/1568009623666230426093255

The Impact of Enhanced Recovery after Surgery Protocol Implementation on Postoperative Pain Management in the Era of Opioid Crisis: The Postchemotherapy Open RPLND Experience

Curr Cancer Drug Targets. 2023;23(11):910-916. doi: 10.2174/1568009623666230426093255.

Authors

Affiliations

¹ Department of Urology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, Scotland, United Kingdom.
² Academic Urology Unit, University of Aberdeen, Aberdeen, Scotland, United Kingdom.
³ Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁴ Department of Medical Oncology, Faculty of Medicine, School of Health Sciences, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
⁵ Department of Medical Oncology, Euroclinic, Athens, Greece.
⁶ Department of Urology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece.
⁷ Department of Anaesthesiology, University Hospital of Larissa, Larissa, Greece.
⁸ Department of Medical Oncology, IASO Thessalias Hospital, Larissa, Greece.
⁹ Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY, USA.

PMID: 37170984
DOI: 10.2174/1568009623666230426093255

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.

Keywords: ERAS; RPLND; cancer patients; enhanced recovery protocol; opioids; pain; retroperitoneal lymph node dissection.