Abstract:
Introduction/Purpose: Healthcare professionals conventionally use opioids to treat pain, but the emergence of
enhanced recovery after surgery (ERAS) shifts pain management from traditional practice to
evidence-based practice. Implementing a standardized pain pathway would result in a
coordinated effort to improve the current ERAS pain management tenet by decreasing variation
in practice, minimizing opioid use with increased multimodal treatment, and upholding positive
patient outcomes from the ERAS program. The purpose of this quality improvement (QI) project
was to implement a standardized pain pathway for ERAS surgical patients based on evidence_x0002_based best practices to improve surgical pain management at a large urban medical center in
Hawaii. Methods:This QI project used a prospective pre-/post-implementation design to determine the
effectiveness of a standardized pain pathway for ERAS patients by evaluating opioid use,
pathway compliance, pain scores, time in the post-anesthesia care unit (PACU), and length of
stay (LOS). Results: After a three-month observation from June to August 2021, average pain scores, time in
the PACU, and LOS were not statistically significant. However, opioid use decreased in the
intraoperative and PACU stages, which was statistically significant for Fentanyl administration.
Overall, a decrease in pain management variation and an increase in multimodal pain practice
were appreciated. Discussion: Pain after surgery is an evident problem with negative consequences that can be
potentially lifelong for the patient. Although this QI project did not find the pain pathway
statistically significant, the clinical value of standardized, evidence-based care integrated into a
coordinated clinical practice to provide exceptional patient care transpired. Therefore,
implementing a standardized pain pathway for ERAS patients can resolve the clinical practice
variation, mitigate opioid use, and improve time in the PACU and LOS.
