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DOI: 10.1055/a-1799-5582
Enhanced Recovery after Surgery Protocol to Improve Racial and Ethnic Disparities in Postcesarean Pain Management
Funding None.![](https://www.thieme-connect.de/media/ajp/202213/lookinside/thumbnails/10-1055-a-1799-5582_210761-1.jpg)
Abstract
Objective The objective of this study was to assess the efficacy of an enhanced recovery after surgery (ERAS) protocol and determine its effect on racial/ethnic disparities in postcesarean pain management.
Study Design We performed an institutional review board-approved retrospective cohort study of scheduled cesarean deliveries before and after ERAS implementation at a single urban academic institution. Pre-ERAS, all analgesic medications were given postoperatively on patient request. The ERAS protocol included preoperative acetaminophen and celecoxib. Postoperatively, patients received scheduled nonsteroidal anti-inflammatory drugs and acetaminophen. Oral oxycodone was available as needed, and opioid patient-controlled analgesia was eliminated from the standard order set. The primary outcome was total opioid use in the first 48 hours after cesarean, pre- and post-ERAS, reported in total milliequivalents of intravenous morphine (MME). A secondary analysis of opioid use and pain scores by racial groups was also performed. Chi-square, independent t-tests, analysis of variance, Mann–Whitney U, and Kruskal–Wallis tests were used depending on variable and data normality.
Results Pre-ERAS and post-ERAS groups included 100 women each. Post-ERAS, total opioid use in 48 hours was less (40.8 vs. 8.6 MME, p < 0.001) and visual analog scale (VAS) pain scores were lower on postoperative day 1 (POD1) and 2 (POD2) (POD1 maximum at rest: 6.7 vs. 5.3, p < 0.001). Pre-ERAS pain scores differed by race with non-Hispanic Black (NHB) patients reporting the highest mean and max VAS pain scores POD1 and POD2 (POD1, maximum VAS at rest: NHB—7.4, non-Hispanic White—6.6, Hispanic—5.8, Asian—4.4, p = 0.006). Post-ERAS, there were no differences in postoperative pain scores between groups with movement on POD1 and POD2.
Conclusion A standardized ERAS protocol for postcesarean pain decreases opioid use and may improve some racial disparities in postcesarean pain control.
Key Points
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ERAS protocols improve postoperative pain control and lower postoperative opioid use.
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Studies show that there are racial and ethnic disparities in postpartum pain control.
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Protocols standardize care and may decrease the effects of provider implicit bias.
Note
Part of this manuscript was presented at the Society for Maternal-Fetal Medicine 41st Annual Pregnancy Meeting on January 29, 2021 (abstract 404).
Publikationsverlauf
Eingereicht: 11. Oktober 2021
Angenommen: 11. März 2022
Accepted Manuscript online:
15. März 2022
Artikel online veröffentlicht:
31. Mai 2022
© 2022. Thieme. All rights reserved.
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