ERAS protocols demonstrate reduced opioid use and length of stay following total knee arthroplasty. The effect on long-term outcomes of esmolol as an opioid reduction strategy as compared to fentanyl is not fully understood. The purpose of this study was to evaluate two ERAS protocols, one utilizing esmolol and one fentanyl, on thirty and sixty-day readmission and emergency department visits.

IRB approval was obtained prior to performing a retrospective chart review of 206 total knee arthroplasty patients at a community hospital. The ERAS utilizing esmolol instead of fentanyl or its derivatives (n=94) was compared to the ERAS group utilizing fentanyl or derivative (n=112) during the perioperative period.  

The patients in the esmolol group had a mean discharge of 2.21 days compared to the fentanyl group with 2.73 days (p<0.05). The esmolol group had fewer emergency department visits 8.5% at 30 days and 2.13% 60 days as compared to 10.71% at 30 days and 8.93% 60 days for the fentanyl group. Additionally, the esmolol group had a 50% reduction in 30 and 60 day hospital readmission rates.

The use of esmolol during the intraoperative period as part of an ERAS protocol and opioid reduction technique decreased length of stay following total knee arthroplasty surgery and decreased readmission and emergency department visits over 30 and 60 days postoperatively in a community hospital setting. This is encouraging evidence that community hospital programs can replicate university type outcomes.

ERAS INCLUDING ESMOLOL FOR TOTAL KNEE ARTHROPLASTY SURGERY DECREASES LENGTH OF STAY WITHOUT INCREASING 30 AND 60 DAY READMISSIONS AND EMERGENCY DEPARTMENT VISITS