A historical prospective study published in Anesthesia & Analgesia indicated that implementation of an enhanced recovery after surgery (ERAS) protocol resulted in an increase in opioid-free anesthesia and multimodal analgesia, but did not modify opioid prescribing practices.

Opioid-free and multimodal analgesia were compared in patients who underwent colorectal surgery the year prior to and the year after implementation of an ERAS intervention (n=194, and n=189, respectively).

Following the ERAS intervention, the rate of opioid prescriptions did not change significantly (P =.4); although opioid prescriptions decreased by 13%, the researchers noted that this was not significant (P =.1).

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In patients with low pain scores at discharge, no preoperative opioid use, and low morphine milligram equivalents consumption before discharge, the opioid prescription rate at discharge was 72% (95% CI, 61%-83%).

The researchers concluded that their results suggest that “physician behavior, rather than the condition of the patient, is the primary determinant of opioid prescribing practices … and should be modified for opioid-free anesthesia and multimodal analgesia to impact the opioid epidemic.”

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Brandal D, Keller MS, Lee C, et al. Impact of enhanced recovery after surgery and opioid-free anesthesia on opioid prescriptions at discharge from the hospital: A historical-prospective study. Anesth Analg. 2017;125(5):1784-1792.