Enhanced Recovery Pathways (ERPs) are collaborative, multidisciplinary approaches designed to minimize surgical stress and hasten functional recovery. Central to ERPs is the cooperation among anesthesia, surgery, and nursing teams to reduce perioperative opioid use through comprehensive analgesic strategies across all perioperative phases. The aim is to achieve optimal analgesia, defined as maximizing patient comfort and functional recovery while minimizing analgesic side effects.
Educating patients preoperatively is crucial, as managing expectations about pain and its treatment plays a vital role in achieving optimal analgesia. Patients should be informed that complete absence of pain is not the goal, but rather managing it to facilitate recovery.
The specifics of ERPs may vary by institution, reflecting differences in practices, surgical procedures, and patient demographics. Effective pathways incorporate a multimodal analgesia plan, extending from preoperative preparation to post-discharge care, including contingency plans for individual patient needs and strategies for managing breakthrough pain without relying heavily on IV opioids.
Adherence to standardized non-opioid ERP protocols has been linked to reduced inpatient opioid use and better surgical outcomes. However, despite ongoing multimodal analgesia, most U.S. pathways currently lack clear guidelines for post-discharge opioid prescribing. Recent evidence suggests that ERPs have not decreased the volume of opioids prescribed at discharge, highlighting a critical area for improvement as ERPs continue to develop.
