Introduction
Enhanced recovery after surgery (ERAS) protocols are being used in various surgical areas in an effort to reduce the use of opioids while responding to the trauma of surgery and postoperative pain. This has become increasingly important in the wake of the opioid crisis and the confirmed role that surgeons can play . [1-3] Cardiac surgeons are not without fault in this crisis, with some studies demonstrating that nearly 10% of cardiac surgery patients go on to develop persistent opioid requirements after cardiac surgery [4] Indeed, ERAS protocols are highlighted for their pain managements strategies which the do not rely on opioids, but the benefits extend beyond pain management. These protocols have demonstrated improvement in length of stay and overall postoperative complications in multiple surgical specialties.[5,6] Hirji et al developed a list of objective data elements which could be collected to demonstrate the benefits of ERAS protocols for cardiac surgery and standardize benchmarks across hospitals.[7] A brief commentary noted the benefits of ERAS protocols for cardiac surgery with early extubation, potentially even in in the operating room immediately after surgery.[8] Williams et al noted in a 1-year study that ERAS protocols for cardiac surgery programs had significantly improved perioperative outcomes including decreased intensive care unit (ICU) stay and hospital length of stay (LOS), decreased incidence of gastrointestinal (GI) complications, and decreased utilization of narcotic pain regimens.[9] Pain management and opioid sparing strategies are only a portion of a comprehensive ERAS protocol. The benefits of these protocols go beyond pain control and are multi-dimensional in their aim to improve the patients’ surgical experience. Adequate pain control may lead to patient satisfaction, overall improved attitude towards the postoperative experience, and increased willingness to participate in postoperative care (eg, physical therapy etc). Currently, the ERAS studies in cardiac surgery have focused on many aspects of improving the postoperative course of patients, including faster time to extubation, decreased length of stay, and others. We developed an ERAS protocol as a quality improvement initiative and sought to evaluate its effect regarding pain control. We hypothesized that with a multi-modality pain regimen and limited narcotics administration, patients’ pain would be well controlled after cardiac surgery, resulting in improved patient satisfaction.