Opioids are a mainstay of pain management. To limit the use of opioids, enhanced recovery after surgery (ERAS) protocols implement multimodal approaches to treat postoperative pain.
This paper aims to be the first to assess the efficacy of an ERAS protocol inclusive of ultrasound-guided, surgeon-led regional blocks for outpatient plastic surgery patients.
A retrospective review of patients undergoing outpatient plastic surgery on an ERAS protocol was performed. These patients were compared to a well-matched group not on an ERAS protocol (pre-ERAS). Endpoints included the amounts of opioid, anti-nausea, and antispasmodic medication prescribed. ERAS patients were given a postoperative questionnaire to assess both pain levels (0-10) and opioid consumption. ERAS patients anticipated to have higher levels of pain had ultrasound-guided anesthetic blocks.
There were 157 patients in the pre-ERAS group and 202 patients in the ERAS group. Patients in the pre-ERAS group were prescribed more opioids (332.3 vs. 100.3 morphine milligram equivalents (MME)/patient; p < 0.001), anti-nausea (664 vs. 16.3mg of promethazine/patient; p < 0.001), and antispasmodic (401.3 vs. 31.2mg of cyclobenzaprine/patient; p < 0.001) medication. Patients on the ERAS protocol consumed an average total of 22.7 MME/patient post-operatively. Average pain scores in this group peaked at 5.32 on POD1 and then decreased significantly daily.
Implementation of an ERAS protocol for outpatient plastic surgery patients with utilization of ultrasound-guided regional anesthetic blocks is feasible and efficacious. The ability to significantly decrease prescribed opioids in this unique patient population is noteworthy.

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