Impact of Multimodal Analgesia in Comparison to Conventional Analgesia in Coronary Artery Bypass Graft Patient with Implementation of an Enhanced Recovery After Surgery Order-set

Background: An Enhanced Recovery After Surgery (ERAS) pilot program was implemented for coronary artery bypass graft (CABG) procedures under a single cardiothoracic surgeon in May 2024 across two community hospitals. We assessed the impact of multimodal analgesia facilitated through the ERAS CABG order-set compared to the non-ERAS (conventional) CABG order-set. Methods: This study was an Institutional Review Board-approved, multi-site, retrospective chart review of participants admitted to two community hospitals for a CABG procedure from June 2024 to January 2025. Participants who utilized the preand post-ERAS or the pre- and post-conventional CABG order-sets were included. The primary outcome was the opioid consumption in morphine milligram equivalents (MME). Secondary outcomes included pain scores, time to extubation, non-opioid analgesic utilization, documented opioid-related toxicities, postoperative and intensive care unit (ICU) lengths of stay (LOS), and 30-day readmission rate. Results: A total of 106 participants were included in this study with 53 participants each in the ERAS and conventional groups, respectively. The median opioid consumption was 21 MME versus 48 MME (p < .001), respectively. The median pain score was 4.67 versus 5.58 (p = .097), respectively. The median ICU LOS was 3 days in both groups (p = .011). Higher incidences of constipation and ileus were reported in the conventional group. Conclusion: Implementation of an ERAS pathway for CABG procedures demonstrated that an ERAS-based multimodal analgesia regimen was associated with decreased opioid consumption, decreased non-opioid analgesic requirements, improved pain scores (49-72 hours postoperatively), and decreased ICU LOS.