lower readmission rates. Texas Health Presbyterian Hospital in Dallas
has earned the 2018 OR Excellence Award for Pain Control for using
those abstract ideas to develop an opioid-sparing pain control pro-
gram that has achieved some tangible — and impressive — results:
• Patient-controlled analgesia pump use before implementation of
the ERAS pathway was about 37%. By June of this year, zero ERAS
patients received PCA pumps to manage their post-op pain.
• During early implementation of the ERAS pathway, patients
received just over 150 morphine equivalent dosing through post-op
day 3. The ERAS program helped slash that amount in half.
That reduction in morphine equivalent dosing is important because
leadership at Presbyterian Hospital launched the program in 2016 dur-
ing the nation's opioid crisis. That year, according to the U.S.
Department of Health and Human Services, 116 Americans died every
day from opioid-related overdoses and 11.5 million people nationwide
misused prescription opioids.
The opioid crisis was a major factor in the decision to launch the
ERAS pathway, according to Nikita Preston, BSN, RN, nurse manager
of the hospital's bariatric unit. "We want to get surgical patients into
and out of the hospital with a reasonable amount of pain that they'd
be able to manage at home," she says.
Concerns about getting patients hooked on opioids is an important
consideration, but the powerful painkillers can also cause a host of
more common post-op complications — such as PONV, prolonged
ileus and respiratory depression — that can slow recoveries.
To limit the use of opioids, Presbyterian Hospital relies on a multi-
modal pain management protocol that includes administering
gabapentin and IV Tylenol before surgery. The protocol also involves
the use of ketamine, dexmedetomidine, neuraxial anesthesia and
transversus abdominis plane (TAP) blocks. Anesthesia providers
4 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • S E P T E M B E R 2 0 1 8
