A Comparison of Multimodal Analgesic Approaches in Institutional Enhanced Recovery After Surgery Protocols for Colorectal Surgery: Pharmacological Agents.

A Comparison of Multimodal Analgesic Approaches in Institutional Enhanced Recovery After Surgery Protocols for Colorectal Surgery: Pharmacological Agents.

Helander EM, Webb MP, Bias M, Whang EE, Kaye AD, Urman RD. A Comparison of Multimodal Analgesic Approaches in Institutional Enhanced Recovery After Surgery Protocols for Colorectal Surgery: Pharmacological Agents. J Laparoendosc Adv Surg Tech A. 2017 Sep;27(9):903-908. 

What is already known:

Multi-modal analgesia is probably the cornerstone of any successful ERAS pathway. The majority of people would understand exactly what it is, but anecdotally different institutions have some different approaches to this. This paper aims to compare and contrast a number of different protocols across North America and one in New Zealand.

What this paper adds:

The group examined a total of 15 protocols. No two were the same. Some were very prescriptive and some just described general principles. Preoperative regimens varied the most. When the same drugs were suggested, dosing also varied quite markedly. Gabapentin varied the most, with doses from 100mg up to 900mg.
Intraoperatively six (out of 15) used lidocaine (either boluses or infusions); eight used Ketamine; but only two used Magnesium.
Postoperatively was the most prescriptive, but again doses were quite varied. Interestingly despite the goal of multi-modal analgesia is to limit the amount of opiates dosing, three protocols used an opiate PCA as standard treatment.
In this study there was definite variation in multi-modal analgesia regimens It was not possible to ascertain exactly why each approach was different. Interestingly despite the obvious greater ERAS experience no European protocols were used in the analysis.

Chris Jones, Guildford. @chrisnjones.