Enhanced recovery protocol for transoral robotic surgery demonstrates improved analgesia and narcotic use reduction

Am J Otolaryngol. 2020 Nov-Dec;41(6):102649. doi: 10.1016/j.amjoto.2020.102649. Epub 2020 Jul 15.


Background: No study has evaluated the impact of the Enhanced Recovery After Surgery (ERAS) protocol on opioid usage among patients undergoing transoral robotic surgery (TORS).

Methods: In this retrospective study, patients undergoing TORS were enrolled in an ERAS protocol and compared to control patients. Primary outcome measures included postoperative mean morphine equivalent dose (MED), Defense and Veterans Pain Rating Scale (DVPRS) pain scores, and opioid prescriptions on discharge.

Results: The mean MED administered postoperatively was lower in the ERAS group (17.6 mg) than in the control group (65.0 mg) (p < .001). Average postoperative DVPRS scores were 2.9 in the ERAS group vs. 4.2 in the control group (p = .042). Fewer patients in the ERAS group received opioid prescriptions on discharge (31.6%) than controls (96.2%) (p < .001).

Conclusion: The TORS ERAS protocol is associated with reduced postoperative opioid usage, lower pain scores, and reduced opioid requirements on discharge.

Keywords: ERAS; Enhanced recovery after surgery; Head and neck; Opioid; TORS; Trans-oral robotic surgery.

MeSH terms

  • Aged
  • Analgesia*
  • Cohort Studies
  • Drug Utilization / statistics & numerical data*
  • Enhanced Recovery After Surgery*
  • Female
  • Head and Neck Neoplasms / surgery*
  • Humans
  • Male
  • Middle Aged
  • Narcotics / administration & dosage*
  • Pain Measurement / methods
  • Pain, Postoperative / diagnosis
  • Pain, Postoperative / drug therapy*
  • Pain, Postoperative / prevention & control
  • Prescriptions / statistics & numerical data*
  • Retrospective Studies
  • Robotic Surgical Procedures / methods*
  • Treatment Outcome


  • Narcotics