Pain management in elective major gynaecology surgery: implementing an enhanced recovery protocol

Abstract

Background: Enhanced recovery after surgery (ERAS) improves outcomes in major surgery.1 Optimising analgesia with a multimodal, opioid-sparing approach allows for faster recovery, reducing hospital stay, costs, and morbidity.2 We implemented a perioperative enhanced recovery protocol (ERP) in elective major gynaecological surgery and analysed its impact on pain scores, side-effects and return to baseline function. Methods: Pre-ERP implementation data were collected from December 2020 to June 2021. Post-ERP data were collected from September to December 2021. Elective gynaecology lists were screened for eligible patients (>18 yr, hysterectomy or myomectomy, open or laparoscopic). Data were prospectively collected using dedicated questionnaires (anaesthetic technique, postoperative analgesic requirement, pain scores, side-effects, and return to baseline). Results: Comparison of 37 patients pre-ERP and 25 patients post-ERP respectively revealed: (1) low pain score (<3/10) on day 1 postoperatively at rest (54% vs 64%), coughing (18% vs 28%) and moving (8% vs 24%), (2) experiencing side-effects: nausea (27% vs 12%), pruritis (16% vs 12%), drowsiness (19% vs 4%), and (3) return to baseline function: ambulating by Day 1 (76% vs 88%), oral intake by Day 1 (92% vs 100%) and discharged by Day 2 (75% vs 84%). Conclusions: After ERP implementation, patients were more likely to report lower pain scores, despite lower average opioid use, and less likely to report associated side-effects (nausea, itching, and drowsiness). Patients were also more likely to be ambulating and eating by Day 1 postoperatively and discharged by Day 2. These results highlight clinical and, potentially, cost-saving improvements. The authors sincerely thank the anaesthetic, recovery, and pain teams at Whipps Cross Hospital. Approval was obtained from the clinical governance department. 1.Patil S, Cornett EM, Jesunathadas J, et al. J Anaesthesiol Clin Pharmacol 2019; 35: S24–82.Bisch SP, Kooy J, Glaze S, et al. Int J Gynecol Cancer 2019; 29; 1372–6