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Recovery and pain plans: ERAS, opioids and what helps

What enhanced recovery programs change, why pain plans use more than one approach, and what research shows about opioids after surgery.

2 minute read5 sources, each checked word for wordLibrary checked October 18, 2026

In short

  • Enhanced Recovery After Surgery programs have shortened hospital stays by 30% to 50%, with similar falls in complications.Review1
  • Guidelines recommend pain plans tailored to the person and the operation, often using several approaches together.E2Good2
  • About 6% of adults started long-term opioid use after surgery, after minor and major operations alike.E2Good3

How sure each claim is:E1StrongE2GoodOfficial textReviewWhat the grades mean

If something is wrong after surgery

This may need care right now. Call 911 for chest pain, trouble breathing, signs of a stroke or heavy bleeding. For fever, wound problems or new symptoms after surgery, call your surgeon's office now; they have someone on call.

What is enhanced recovery (ERAS)?

The ERAS Society publishes guidelines for many operations. Changes include carbohydrate drinks 2 hours before surgery instead of overnight fasting, smaller incisions and balanced fluids. Others are fewer drains and tubes, getting up early, and food and drink on the day of the operation.Review1

These protocols have shortened hospital stays by 30% to 50%, with similar reductions in complications, readmissions and costs.Review1

How is pain managed?

Most people have pain after surgery, but evidence suggests fewer than half report adequate relief.E2Good2

A guideline from the American Pain Society and anesthesia societies says pain management should follow a plan tailored to the person and the procedure. It recommends multimodal approaches (several kinds of pain relief together) in many situations.E2Good2

For hip and knee replacement, an international consensus recommends peripheral nerve blocks unless they are contraindicated.E2Good4

Opioids after surgery

In a large US study, new persistent opioid use after surgery occurred in 5.9% to 6.5% of adults. The rate was 0.4% in people who did not have surgery.E2Good3

Rates were similar after minor and major operations and were linked with behavioral and pain disorders rather than the size of the operation.E2Good3

Opioid labels warn of serious, life-threatening or fatal slowed breathing, even when used as recommended.Official text5

Questions you might bring to your anesthesia team

  1. What is my pain plan, including medicines that are not opioids?
  2. Will I have a nerve block, and how long will it last?
  3. How long should I expect to need opioids, if at all, and how do I stop them?
  4. Is this hospital's surgery part of an enhanced recovery program?
  5. Who do I call after hours if something seems wrong?

Every claim in this guide was written from its sources and checked against them word for word. Its clinical review by Dr. Recio, a practicing nurse anesthesiologist (CRNA), is pending. This line changes when the review is done.

Sources

Each source opens on PubMed, DailyMed or the publisher's page. Under each one are the exact words from it that this page relies on, copied word for word and checked against the original.

  1. Enhanced Recovery After Surgery: A Review. Ljungqvist O, JAMA Surg, 2017. Review Expert review
    The words this page rests on
    Enhanced Recovery After Surgery protocols have resulted in shorter length of hospital stay by 30% to 50% and similar reductions in complications, while readmissions and costs are reduced.
    The ERAS Society, an international nonprofit professional society that promotes, develops, and implements ERAS programs, publishes updated guidelines for many operations, such as evidence-based modern care changes from overnight fasting to carbohydrate drinks 2 hours before surgery, minimally invasive approaches instead of large incisions, management of fluids to seek balance rather than large volumes of intravenous fluids, avoidance of or early removal of drains and tubes, early mobilization, and serving of drinks and food the day of the operation.
  2. Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council. Chou R, J Pain, 2016. E2Good Guideline
    The words this page rests on
    Safe and effective postoperative pain management should be on the basis of a plan of care tailored to the individual and the surgical procedure involved, and multimodal regimens are recommended in many situations.
    Most patients who undergo surgical procedures experience acute postoperative pain, but evidence suggests that less than half report adequate postoperative pain relief.
  3. New Persistent Opioid Use After Minor and Major Surgical Procedures in US Adults. Brummett CM, JAMA Surg, 2017. E2Good Observational study
    The words this page rests on
    The rates of new persistent opioid use were similar between the 2 groups, ranging from 5.9% to 6.5%. By comparison, the incidence in the nonoperative control cohort was only 0.4%.
    New persistent opioid use after surgery is common and is not significantly different between minor and major surgical procedures but rather associated with behavioral and pain disorders.
  4. Peripheral nerve block anesthesia/analgesia for patients undergoing primary hip and knee arthroplasty: recommendations from the International Consensus on Anesthesia-Related Outcomes after Surgery (ICAROS) group based on a systematic review and meta-analysis of current literature. Memtsoudis SG, Reg Anesth Pain Med, 2021. E2Good Consensus statement
    The words this page rests on
    PNB use is recommended for patients undergoing THA and TKA except when contraindications preclude their use. Furthermore, the alignment of provider skills and practice location resources needs to be ensured.
  5. Fentanyl Citrate Injection, USP, Prescribing Information. Hospira, Inc., 2026. Official text FDA label
    The words this page rests on
    Serious, life-threatening, or fatal respiratory depression has been reported with the use of opioids, even when used as recommended. Respiratory depression, if not immediately recognized and treated, may lead to respiratory arrest and death.