New research by the Montefiore Einstein Department of Anesthesiology found an enhanced recovery after cardiac surgery protocol introduced in 2020 has significantly reduced the use of opioids among cardiac patients, both immediately following surgery and after they are discharged, resulting in less chance of patients becoming dependent on opioids and fewer of the drugs going into the community. Reducing opioid use is particularly important in the Bronx, where, according to the Centers for Disease Control and Prevention, the drug overdose rate was 38.7 per 1,000 in 2020, up from 8.3 in 2010.

“We think there’s a lot of benefits to minimizing the use of opioids and in certain cases eliminating narcotics completely on hospital discharge, allowing us to control the opioid medications that are out there,” said Jonathan D. Leff, MD, FASE, Chief, Cardiothoracic Anesthesiology, Co-Director, Montefiore Einstein Center for Heart and Vascular Care, Vice Chair, Professional Affairs, and Professor, Anesthesiology and Cardiovascular & Thoracic Surgery, Montefiore Einstein, who led the study. “As long as the patient isn’t having a lot of pain in recovery, we’re able to send them home often with minimal to no narcotics.”

Montefiore Einstein’s Division of Cardiothoracic Anesthesia and the Anesthesiology Research Lab started collaborating on the Enhanced Recovery After Surgery (ERAS) protocol in 2019 with the aim of reducing opioid use while ensuring patients had high levels of pain relief. The new protocol uses a mix of nonnarcotic pain relievers and analgesics, such as Tylenol, combined with nerve blockers post-surgery, and a low-dose ketamine drip during surgery, which together help manage pain and control post-surgery nausea and vomiting.

Researchers, who began analyzing results in 2022, included data from more than 2,000 surgeries between 2016 and June 2021 to determine what, if any, impact the new ERAS protocol had on the number of opioids patients received.

The study shows that the new protocol led to just 8.4% of patients receiving postoperative opioid prescriptions, compared to 20.5% previously. There also was a 23% reduction in the amount of intravenous (IV) opioids administered to patients following surgery.

“This data shows that we can safely reduce narcotic use and still have the same, if not better, patient outcomes,” Dr. Leff said. “One of the highlights of working on the multidisciplinary ERAS initiative was the opportunity to collaborate with everyone who contributes to a patient’s care pre- and post-surgery—the surgical unit, preoperative team, hematologists, physical therapists and Post-Anesthesia Care Unit (PACU) staff.”

In developing the protocol, the team utilized anesthesia providers’ expertise and took into account comorbidities that affect many Montefiore Einstein patients, including hypertension, obesity and unmanaged diabetes.

Going forward, researchers plan to continue assessing other potential benefits of the new ERAS protocol, including the impact of opioid reduction on outcomes such as postoperative delirium, length of stay in the hospital and postoperative respiratory function.