Effect of Multimodal Analgesia on Opioid Use After Open Ventral Hernia Repair.

Journal Article (Journal Article)


There is limited data on enhanced recovery after surgery (ERAS) protocols after ventral hernia repair (VHR). This study reports the impact of multimodal analgesia on opioid use after open VHR.


Retrospective review of open VHR treated during the initial 6 months after ERAS implementation. Protocol focused on opioid sparing using intraoperative ketamine and/or lidocaine infusion, selective epidural anesthesia, and postoperative ketamine infusion, ketorolac, and acetaminophen. Four groups were analyzed: 1-ERAS protocol with epidural analgesia, 2-historical controls with epidural analgesia prior to ERAS, 3-ERAS protocol without epidural, and 4-historical controls without epidural analgesia, prior to ERAS. Continuous variables were analyzed using ANOVA or Kruskal-Wallis tests, and subgroup analysis using Student's t test or Mann-Whitney U test. Discrete variables were analyzed using Pearson's chi-square test or Fisher's exact test.


Patients differed in hernia width, but were similar in comorbidity and operative technique. There was no difference in length of stay or readmission. Use of ERAS nearly eliminated patient-controlled analgesia use (group 1, 2.7%; group 2, 68.4%; group 3, 0%; group 4, 65.7%; p < 0.001). ERAS significantly reduced narcotic requirements on postoperative days 0, 1, and 2 (p < 0.001). To account for the bias of selective epidural analgesia, groups 1 and 2 (epidural) and groups 3 and 4 (no epidural) were compared separately. Opioid requirement and PCA use remained significantly lower in patients in the ERAS pathway.


Implementation of multimodal analgesia in the perioperative and postoperative setting significantly reduced opioid use after VHR.

Full Text

Duke Authors

Cited Authors

  • Warren, JA; Stoddard, C; Hunter, AL; Horton, AJ; Atwood, C; Ewing, JA; Pusker, S; Cancellaro, VA; Walker, KB; Cobb, WS; Carbonell, AM; Morgan, RR

Published Date

  • October 2017

Published In

Volume / Issue

  • 21 / 10

Start / End Page

  • 1692 - 1699

PubMed ID

  • 28808868

Electronic International Standard Serial Number (EISSN)

  • 1873-4626

International Standard Serial Number (ISSN)

  • 1091-255X

Digital Object Identifier (DOI)

  • 10.1007/s11605-017-3529-4


  • eng