Table 4.

Postoperative opioid use.

Author(s), Year	Patients	Analgesia Management	Opioid Use	p
Hendy et al., 2022 OS [17]	100 ERAS	Pre-emptive analgesia: acetaminophen (650 mg) and gabapentin (300 mg) 30 min before anaesthesia Ultrasound-guided serratus anterior plane block is performed within one hour from arrival to ICU. Fentanyl (25 mcg) is delivered directly through IV injections every 5 min, as needed (with a maximum of 300 mcg over 6 h) and/or acetaminophen (1000 mg) every 6 h, not to exceed 4 g/day if the nerve block was not sufficient.	11.58 ± 4.43 morphine milligram equivalent (ICU consumption)	<0.001
	103 control	From the time of arrival to the ICU until extubation, fentanyl is infused at 25–100 mcg/h. After extubation, fentanyl (25 mcg) is delivered directly through IV injections every 5 min, as needed (with a maximum of 300 mcg over 6 h). Hydromorphone (1–2 mg) is delivered subcutaneously every 3 h as needed, and 2–4 mg orally every 3 h as needed. Non-opioid adjuvants. Acetaminophen (1000 mg) every 6 h, not to exceed 4 g/day. Ketorolac (15 mg) is given intravenously every 8 h (not given if bleeding or if the patient has abnormal kidney function)	50.58 ± 11.93 morphine milligram equivalent (ICU consumption)
Fleming et al., 2016 OS [18]	52 ERAS	Gabapentin, 600 mg PO preoperatively Opioid (morphine) infusion discontinued after extubation Analgesia after extubation: regular paracetamol and codeine with additional oral solution of morphine sulphate, if needed	Opioid infusion duration (days): 0 (0–0)	<0.01
	53 control		Opioid infusion duration (days): 3 (2–3)
Williams et al., 2019 OS [19]	443 ERAS	Preoperative: gabapentin (300 mg) and acetaminophen (1000 mg) given orally in preoperative holding area Intraoperative: fentanyl IV given as needed for pain but typically <1 mg for entire case Hydromorphone (0.5–1 mg) given near completion of surgery If time since preoperative acetaminophen dose significantly exceeds 6 h, 1 dose of acetaminophen (1000 mg) IV considered Postoperative acetaminophen (1000 mg) every 6 h Gabapentin (300 mg) twice daily, weaned after POD 5 Oxycodone (5–10 mg) every 4 h as needed (liquid given through orogastric tube while intubated, orally once extubated and tolerating clears) Fentanyl IV for breakthrough pain resistant to oral medication management	Mean 21 milligrams of intravenous morphine equivalent	<0.01
	489 control		Mean 29 milligrams of intravenous morphine equivalent
Zaouter et al., 2019 OS [20]	23 ERAS	Intraoperative: pre-emptive multimodal analgesic strategy was implemented at induction and consisted of boluses of 0.5 mg/kg of ketamine After sternum closure, wound infiltration with a total of 20 mL of 0.75% ropivacaine was applied along with administration of a multimodal analgesia encompassing 1 g of acetaminophen, 100 mg of ketoprofen, 0.3 mg/kg of nefopam and 0.1 mg/kg of morphine Postoperative: patient-controlled analgesia morphine and nefopam (65 mg/kg/h) and pregabalin (150 mg) once a day for the first 5 PODs. When patients were discharged from the ICU, 100 mg of ketoprofen was prescribed twice a day with breakthrough and 100 mg of tramadol every 4 to 6 h, as required	2 (0–12) total mean milligrams of intravenous morphine equivalent	p = 0.09
	23 control	Intraoperative: target-controlled infusion with either sufentanil or remifentanil; during sternum closure using 0.2 mg/kg of morphine, 1 g of acetaminophen, and 0.3 mg/kg of nefopam when not contraindicated Postoperative: patient-controlled analgesia morphine (containing 0.05 mg of droperidol for each milligram of morphine) and 65 mg/kg/h of nefopam for the first 48 postoperative hours or until discharge from ICU. When patients were discharged from the ICU, 100 mg of ketoprofen was prescribed twice a day with breakthrough and 100 mg of tramadol every 4 to 6 h, as required	7 (3–12) total mean milligrams of intravenous morphine equivalent
Bills et al., 2022 OS [23]	133 ERAS	No preoperative therapy Postoperative: acetaminophen (1000 mg) every 8 h; gabapentin (100–300 mg) every 8 h; methocarbamol (250–500 mg) every 6 h for 5 days with the option of extending therapy or making dose adjustments based on renal function, as well as tolerability and response. Lidocaine patches are also commonly added in these patients for relief of pain and ketorolac is occasionally used for breakthrough pain in patients with normal renal function	75.8 (40.6–128.7) cumulative oral mean milligrams of intravenous morphine equivalent (72 h)	p = 0.09
	185 control		105.4 (37.9–165.0) cumulative oral mean milligrams of intravenous morphine equivalent (72 h)
Loria, 2022 OS [24]	216 ERAS	Preoperative Acetaminophen (1 g) 2 h before surgery Gabapentin (300 mg) 2 h before surgery Intraoperative Recommend reduced opioid use to <500 mg fentanyl Local anaesthetic with liposomal bupivacaine 10 mL chest tube sites 15 mL incision Postoperative Dexmedetomidine (initiated in OR, continued until extubation) Acetaminophen (650 mg) scheduled every 6 h Lidocaine 5% transdermal patch, applied to bilateral back or chest Gabapentin, 100 mg TID, 100 mg BID if renal impairment Tramadol, 50–100 mg PO every 6 h PRN for mild pain (every 12 h for CrCl < 30, max 200 mg/d) Oxycodone, 5–10 mg PO every 4 h PRN for moderate pain IV opioids (eg, hydromorphone, fentanyl), PRN severe/breakthrough pain	261 milligrams of intravenous morphine equivalent	p < 0.001
	250 control		459 milligrams of intravenous morphine equivalent