NRMC Implements Enhanced Recovery after Surgery


Pain is a common reason for seeking medical treatment and often the painkiller of choice is a potent opioid drug. Opioid painkillers include a wide variety of compounds including straight opium poppy extracts, and chemically modified or manmade compounds that act similarly. Heroin, codeine, and morphine are natural derivatives of opium. As much as they are effective for pain relief, they can be dangerous. The difference between the amount needed to feel their effects and the amount needed to kill a person is small and unpredictable. Additionally, opioid painkillers can quickly develop a user’s tolerance and dependence on the drug.

Appropriately deemed an epidemic or crisis, opioid drug abuse, and overdose have continued to rise and are now at an all-time high. Death from the overdose of opioids is surpassing other national leading causes of death. According to the National Safety Council, more than 100 people die from opioid drugs every day in the U.S. As a result, healthcare professionals are developing alternative pain management plans in order to reduce or even eliminate the need for opioid painkillers.

Over the past year, Nevada Regional Medical Center (NRMC) has been working to adopt a series of protocols recommended by the American Association of Nurse Anesthetists entitled Enhanced Recovery after Surgery (ERAS). Recognizing that within each phase of surgery, opportunities exist to minimize opioid use as well as reduce surgery complications, the ERAS method employs the use of multiple techniques to achieve these two goals. This requires the concerted actions of many departments including the surgical team, anesthesia, nursing, pharmacy, and nutritional services. Implementation of ERAS protocols has proven to result in faster recovery after surgery with less pain, and minimization of opioid painkiller use. Steve Marquardt, Certified Registered Nurse Anesthetist at NRMC, has witnessed firsthand the positive impacts of ERAS efforts made so far.

“It’s been found that an opioid addict’s first exposure is often in a hospital or surgical setting,” Marquardt said. “As a smaller hospital, we have the advantage of being able to focus on our ability to reduce that exposure. It starts with educating the patient, then a series of actions that reduce opioids and encourage healing. When we use this system, we see a substantial reduction in negative side effects. Patients wake up less groggy, with less pain. They are able to recover faster and go home sooner, with less need for a narcotic prescription after surgery.”

The ERAS method also recommends limited fasting. Traditionally, surgery would require the patient to be fasting for a long period, putting the body in a catabolic, or starvation state. By giving the patient a carbohydrate-rich beverage two hours before surgery, the body avoids this starvation state and is in a much better position to heal.

These days, NRMC surgeons are using ERAS methods to keep pain under control, using multiple alternative pain interventions. For example Dr. Joseph Dodd will typically order a pre-operative non-steroidal anti-inflammatory (NSAID) and Gabapentin (an anti-seizure medication that also blocks nerve pain) and Dr. Scott Compton will often order a regional nerve block for his surgeries.

“There are many parts that could still be implemented, but our doctors will have to agree on what is best for our patients before we have a fully effective policy,” Marquardt said. “The good news is that we are seeing positive results from what we’ve done so far and it will only get better. That’s good for our patients and our communities.” 

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About Nevada Regional Medical Center

Serving a six-county area since 1937, Nevada Regional Medical Center is a 71-bed acute, intensive and skilled care hospital. Nevada Regional Medical Center has earned recognition as a respected regional medical center for its comprehensive health care services, skilled and caring employees and state-of-the-art medical technology. Staff represent more than a dozen medical specialties, including family practice, women’s services, neurology, urology, psychiatry, orthopedics, wound care services, and general, vascular, thoracic and oncological surgery. Additionally, consultation clinics are held regularly by specialists in oncology, pulmonology, podiatry, ear, nose, and throat and cardiology.

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