Implementation of a pediatric enhanced recovery pathway decreases opioid utilization and shortens time to full feeding

Implementation of a pediatric enhanced recovery pathway decreases opioid utilization and shortens time to full feeding

Phillips et al. Implementation of a pediatric enhanced recovery pathway decreases opioid utilization and shortens time to full feeding. J Pediatr Surg. 2019 Nov 15. pii: S0022-3468(19)30718-3. doi: 10.1016/j.jpedsurg.2019.09.065. 

What is already known:

There has been a drive to develop ERAS pathways for paediatric care with several institutions and groups offering publications which are largely variations on existing adult guidelines. Many previous studies on the efficacy of ERAS in paediatric surgery have focussed on laparoscopic surgery and shown benefits in reduced hospital length of stay, length of time to restoration of bowel function and opioid consumption.

What this paper adds:

This single-institution, retrospective study describes its development and implementation of an ERAS guideline for paediatric open and laparoscopic inflammatory bowel surgery. From an initial adult pathway of 21 elements they selected 15 for inclusion in their paediatric study. The ERAS cohort were significantly more likely to receive regional blockade and required less opioid postoperatively along with a significantly shorter time to oral fluid intake. Postoperative complications were no different to the standard care group. The results of this study are encouraging in showing that elements of adult ERAS pathways are translatable to paediatrics with effective results. Reduced opioid consumption is also particularly reassuring in light of the potential for harm in using opioids in the paediatric population.

Ben Morrison, Guildford @blouism