Opioid Sparing by ERAS Protocol in Cleft Lip and Palate Craniofacial Surgery

Abstract

Background: Enhanced Recovery After Surgery (ERAS) protocols have been shown to improve both clinical outcomes and cost savings in various perioperative settings. Our study focuses on the effects of ERAS protocol in craniomaxillofacial surgery in a single institution within 2 years leading up to and following implementation. The purpose of this research is to quantify the changes in effective pain management in pediatric patients undergoing craniomaxillofacial procedures before and after our ERAS protocol, which did not include IV acetaminophen. We hypothesize that ERAS protocol, even without IV acetaminophen, will provide effective pain management while decreasing the opioid use4 in the perioperative and postoperative period without associated complications from NSAID therapy. Methods: A retrospective chart review was conducted on 137 pediatric patients that underwent craniofacial surgery between July 1, 2014, and June 30, 2020. Patients were divided into 2 cohorts: Pre-ERAS and Post-ERAS with the implementation of ERAS on July 1, 2017. Results: Post-ERAS cohort showed increased NSAID use in the preoperative and postoperative period for both IV and PO ( P = .006 and P = .0064). Morphine use showed no immediate changes until a year after implementation with a statistically significant reduction ( P = .0051). When stratified by procedure type, IV NSAID (Ketorolac) use increased in Palatoplasty procedures ( P = .0154) while PO NSAID (Ibuprofen) use increased in Cleft Lip Repair ( P = .0224). Conclusion: ERAS protocol implementation can provide benefit for pediatric patients undergoing craniomaxillofacial surgery by decreasing opioid use, even in the absence of IV acetaminophen. Outcomes may potentially be delayed in the immediate post-implementation period. This study can add to the expanding literature for the use of ERAS protocol in craniomaxillofacial surgical settings. Further studies can include analyzing potential barriers to implementation and future complications related to ERAS long term outcomes.