For a study, the researchers sought to determine if enhanced recovery after surgery (ERAS) may reduce postoperative opioid use in ambulatory anorectal surgery without compromising patient pain or satisfaction. Over 30 days after surgery, ambulatory anorectal patients were randomly assigned to either ERAS (experimental) or regular treatment (surgeon’s option) for pain management (control). The primary outcome was the total number of days spent using opioids. Pain and satisfaction levels over many time points and new chronic opioid use were secondary objectives. Patient-reported pain and satisfaction were assessed using the Visual Analog Scale, Functional Pain Scale, and EQ-5D-3L. The results of the univariate analysis were compared across the board and at different time points. Researchers compared pain and satisfaction measurements between groups using a 2-way mixed ANOVA. A total of 32 patients were randomly assigned to each of the 2 arms (64 total). After discharge, the control group ingested considerably more opioids (median 121.3MME versus 23.5MME, P<0.001). Control patients were much more likely to request extra narcotics (P=0.004), make unexpected phone calls (P=0.009), and attend the clinic unintentionally (P=0.003). The control group used opioids for a considerably extended period (mean 14.4 vs 2.2, P<0.001). In addition, 3 control patients (9.4%) reported new persistent opioid use compared to none of the experimental patients. Over time, the mean scores for global health, EQ5D-3L, Visual Analog Scale, and Functional Pain were comparable. In ambulatory anorectal surgery, an ERAS approach was practical and resulted in lower opioid use and healthcare use with no difference in pain or patient satisfaction. This casts doubt that long-acting opioids were required for adequate postoperative pain treatment.
