BoardsBridgeOpioid-Sparing ERAS Protocols for Postoperative Pain
Multimodal analgesia, regional anesthesia, and enhanced-recovery bundles — minimizing opioids without sacrificing analgesia
ERAS is a bundled, evidence-based perioperative care pathway that uses multimodal non-opioid analgesia (acetaminophen, NSAIDs, gabapentinoids, regional/neuraxial blocks), normothermia, euvolemia, and early mobilization to reduce opioid consumption, PONV, ileus, and length of stay while maintaining analgesia.
If you forget
ERAS = Enhanced Recovery After Surgery — a BUNDLED multimodal pathway, NOT 'opioid-free anesthesia'
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Key numbers
- Acetaminophen 1 g IV/PO q6h, max 4 g/day adult (15 mg/kg q6h peds, max 75 mg/kg/day)
- Celecoxib 200-400 mg PO q12h; AVOID in CABG history, sulfa allergy, CrCl <30, severe HF
- Ketorolac 15-30 mg IV q6h, max 5 days; AVOID CrCl <30, hypovolemia, recent GI bleed
- Gabapentin 300-600 mg PO TID; renal-dose-adjust if CrCl <60; max 3600 mg/day
- IV lidocaine bolus 1-1.5 mg/kg then 1-2 mg/kg/hr infusion; typically stopped at end of surgery, some protocols continue 12-24 h postop (toxicity >5 mcg/mL)
- Ketamine 0.1-0.5 mg/kg IV bolus ± infusion 0.1-0.3 mg/kg/hr to prevent opioid-induced hyperalgesia
- TAP block: 15-20 mL 0.25% bupivacaine each side; max bupivacaine 3 mg/kg total
Uri Rozen, MD — Licensed Physician, Israel
Source guidelines: ASA ERAS Guidelines 2023 · ASAM OUD Focused Update 2020
Re-review cadence: 12 months from reviewed date.
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Card ID: opioid-sparing-eras · Path: aba.pain.acute-postoperative.opioid-sparing-eras