Investigating the Effects of a Lower Extremity Bypass Enhanced Recovery Pathway on Postoperative Opioid Use and Patient Pain Scores

Enhanced recovery pathways (ERPs) are multimodal protocols designed to reduce perioperative stress and promote early normalization after surgery. A primary tenant of ERP is improve postoperative pain control while limiting opioid utilization decrease the likelihood addiction. The purpose this study was determine effects a lower extremity bypass (LEB) implementation on oral morphine equivalents (OMEs) patient scores. single-institution retrospective review patients undergoing elective infrainguinal LEB from January 2016 July 2022 performed (N = 393). implemented in May 2018. Patients were divided into pre-ERP (n 161) 232) groups. Average daily median OMEs required numerical scores (range, 0-10) compared between groups across days. This analysis repeated stratified by indication for surgery (claudication, rest pain, tissue loss). Perioperative regimen consisted preoperative fascia iliaca nerve blockade, administration gabapentin acetaminophen, as needed opioids postoperatively. Within group, 91.9% received 74.9% analgesia. averages significantly group day 0 (POD) at 2.9 ± 3.2 vs 3.9 (P .003) (Fig 1). experienced higher levels POD1 POD2 5.0 3.0 4.1 .005) 4.7 3.1 2.8 .017). POD0 (75.0 51.8 318 263.2; P < .001 59.3 42.9 124.6 193.5; .001) 2). Throughout stay, post-ERP average with (66.1 64.7 91.1 79.7; .001). Stratification yielded similar pattern Figs 1 2 regarding OME comparing post-ERP. Overall, surgical did not affect or utilization. However, trended towards preoperatively Across entire cohort, correlated medium correlation coefficient ranging 0.3 0.5 demonstrates requirements patients. transient period rebound effectiveness an pathway reducing overall but also identifies targets optimization control.Fig 2Average equivalent (OME) non-enhanced (ERP) (*significant difference groups).View Large Image Figure ViewerDownload Hi-res image Download (PPT)