Implementing ERAS in Pediatric Surgery: The Impact of Standardized Nonopioid Pain Protocols On Postoperative Recovery

Abstract

Objective: To evaluate the implementation of an Enhanced Recovery after Surgery pathway using standardized nonopioid analgesia and to assess its association with postoperative recovery in pediatric surgical patients.

Methods: A prospective hospital based study was conducted at Lady Reading Hospital Peshawar from 23 March 2025 to 23 February 2026. A total of 97 pediatric patients undergoing surgery were included. A standardized Enhanced Recovery after Surgery pathway was implemented with emphasis on nonopioid analgesia early oral intake early mobilization and predefined discharge criteria. Postoperative pain scores rescue opioid requirements oral intake mobilization hospital stay and complications were assessed.

Results: Standardized nonopioid analgesia was achieved in 94 patients (96.9%). Rescue opioid medication was required in 14 patients (14.4%). Mean pain scores decreased from 3.1 ± 1.2 at 6 hours to 1.9 ± 0.9 at 24 hours. Early oral intake was achieved in 84 patients (86.6%) while 81 patients (83.5%) were mobilized within 24 hours. Mean hospital stay was 2.7 ± 1.4 days. High pathway adherence was associated with earlier oral intake and mobilization and shorter hospital stay.

Conclusion: Standardized nonopioid analgesia within an Enhanced Recovery After Surgery pathway was associated with favorable postoperative recovery in children. Reduced opioid rescue requirements and earlier functional recovery were observed.