Patients undergoing a select number of surgeries at Albany Med are experiencing improved recoveries, shorter hospital stays, and better pain management with less need for opioids for pain, thanks to a new, multidisciplinary approach to surgical care.

The Enhanced Recovery After Surgery (ERAS) initiative was recently adopted at Albany Med and among its measures is a de-emphasis of the use of opioid-based medications to treat pain. Albany Med’s clinicians focus, instead, on patient education, a more targeted approach to anesthetics, and frequent visits from members of a patient’s surgical team, who monitor progress and encourage movement and helpful exercises during recovery.

The result is that patients are not only able to return home much more quickly, but are able to do so with fewer opioids in hand, an important benefit in the face of the national opioid addiction epidemic.

“ERAS doesn’t prohibit the use of opioid medications all together,” said Igor Galay, MD, assistant professor of anesthesiology, who first advocated for Albany Med to adopt the protocol after studies showed positive results in improved patient satisfaction and recovery. “If a patient’s best option is an opioid to treat pain, we will, of course, use it. But opioids can often impede a patient’s recovery, because of their many side effects, which can include delirium and vomiting.”

This is especially true for patients undergoing bowel surgery, said Brian Valerian, MD, associate professor of surgery and the first surgeon at Albany Med to adopt the ERAS protocol.

“The intestines ‘sleep’ after bowel surgery,” Dr. Valerian explained, “and patients can’t leave the hospital until they begin working again. Opioids not only further slow the intestines, but they can also cause sedation, dizziness, nausea. and breathing difficulties.”

Under ERAS, Valerian said, the stress of surgery on patients is minimized, enabling them to recover faster. “By eliminating the harmful side effects of these medications, patients are able to eat and drink and begin moving sooner following surgery, which leads to quicker recoveries with fewer complications.” Dr. Valerian also noted that, under ERAS, Albany Med has seen a reduced length of stay from 4 to 6 days to a new average of 1 to 3.

“We begin by educating the patient upfront that some pain after surgery is inevitable. Therefore, our goal is not to eliminate pain completely, but to make it tolerable so that patients can function after surgery,” said Galay. “All of this can be accomplished with no or very little opioid medications. By setting realistic expectations and doing targeted pain management, we are able to improve our patients’ experience and expedite their recovery.”

Unlike in traditional surgery, under ERAS, anesthesiologists are now involved in pain management beyond the operating room. Nerve blocks are used with local anesthetic to target pain right where it happens, combined with different types of pain killers that work via different mechanisms.

“Everyone experiences pain differently even after the same surgery,” explains Galay. “We pay close attention to what our patients tell us about their pain and treat it accordingly. Some people just need reassurance that they are doing well, and others may need additional nerve blocks or a different type of pain killer. Our goal is to aggressively treat pain so that our patient can move, eat, and sleep better.”

Based on the success of ERAS, the hospital hopes to expand the program to other surgical areas. The Division of Urology now follows opioid-free protocols for all its kidney surgeries, and the hospital recently adapted ERAS for bladder surgeries and abdominal cancer surgeries.

“We do a lot of kidney surgeries—at times as many as three or four a week—so it’s been helpful to look at how ERAS is impacting patients through the lens of a high-volume procedure,” said urologic surgeon Ronald J. Kaufman, Jr, MD, associate professor of surgery, who added he has been struck by what he’s observed.

“We see some of our patients getting out of bed and moving around the recovery room, which is pretty unprecedented,” Dr. Kaufman said. “They can do this because their pain is more controlled.”

He called the results of the initiative “very impressive,” and said he looks forward to adopting the protocols for other surgeries he performs.