Evaluating the Effectiveness of ERAS Protocols and Opioid-Free Anesthesia in Spine Surgery Recovery: A Systematic Review

Enhanced Recovery After Surgery (ERAS) protocols have transformed perioperative care, improving patient outcomes, reducing opioid consumption, and enhancing the efficiency of healthcare systems. This article explores the impact of ERAS pathways on surgical and rehabilitation outcomes, with a specific focus on opioid consumption and pain management. A literature search was performed across PubMed (n=۲۱۸), Scopus (n=۳۵۷), Web of Science (n=۱۰۰), and Embase (n=۲۸۸). for studies from ۲۰۱۶ to ۲۰۲۴, using keywords related to spine surgery, ERAS protocols, opioid-free anesthesia, and postoperative recovery. A total of ۱,۲۸۴ records were identified across four electronic databases: PubMed (۲۱۸), Scopus (۳۵۷), Web of Science (۱۰۰), and Embase (۲۸۸); an additional search on Google Scholar (۳۲۱) and ProQuest (۲۸۸) was also conducted. ۷۷۰ records were screened, leading to ۱۳۳ full-text articles assessed for eligibility. Of these, ۲۰ studies were included based on the PICO framework. Data extraction was conducted independently by two authors, and quality was assessed using the Cochrane Risk of Bias tool and the Newcastle-Ottawa Scale. The implementation of ERAS protocols was consistently associated with reduced length of stay (LOS), with average reductions ranging from ۱.۱ to ۱.۶ days. Opioid-free anesthesia and multimodal analgesia strategies led to significant reductions in perioperative opioid consumption, with some studies reporting decreases of up to ۹۵% in morphine equivalents ERAS protocols and opioid-free anesthesia led to earlier mobilization (observed in ۸۵–۹۴% of patients), improved patient satisfaction (reported in ۷۰–۹۰% of studies), and fewer opioid-related complications, including constipation (−۲۵%), urinary retention (−۲۰%), and nausea (−۱۸%). Only a small number of studies (~۱۰%) reported no significant difference in pain scores, indicating that effective pain control was generally maintained. The integration of ERAS protocols and opioid-free anesthesia demonstrates significant benefits in enhancing recovery after spine surgery, including reduced pain, quicker recovery, and decreased hospital stays. Despite these positive outcomes, further research is needed to standardize these protocols and examine their long-term effects. Surgeons should consider these interventions as part of a comprehensive strategy to optimize postoperative care for spine surgery patients.

کلیدواژه ها:

Spine Surgery ، ERAS protocol ، opioid-free anesthesia ، Postoperative recovery ، Pain management