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A significant clinical trial in the United States has demonstrated that a specialized recovery program for children undergoing gastrointestinal surgery can significantly decrease opioid consumption and accelerate their healing process. Led by researchers from Northwestern University and Ann & Robert H. Lurie Children’s Hospital of Chicago, the study revealed that kids participating in the program used 56% fewer opioids during their hospital stay compared to those receiving standard care. The findings were published in JAMA Surgery.
This recovery approach, called an “enhanced recovery protocol,” incorporates 21 specific steps designed to facilitate smoother healing before, during, and after surgery. The trial involved nearly 600 children and teenagers aged 10 to 18 from 18 pediatric hospitals nationwide, marking one of the largest pediatric surgery studies in the U.S. Most participants had surgeries related to inflammatory bowel disease or other gastrointestinal issues.
Some parts of the program start even before surgery, such as allowing patients to drink clear liquids like apple juice on the morning of their procedure instead of fasting for extended periods. During surgery, doctors aim to use minimally invasive techniques whenever possible. Post-surgery, patients are encouraged to eat and walk sooner than traditional protocols, with a focus on reducing the use of tubes and drains and promoting pain management strategies that minimize opioid use.
Findings indicate that children who completed at least 13 of the 21 recovery steps experienced notably better outcomes. On average, they began eating earlier, stayed in the hospital for one less day, and had about half the risk of complications compared to those who received fewer steps. Lead author Mehul Raval noted that many key elements of the program were shaped by feedback from patients and families to not only reduce pain but also alleviate stress and anxiety during recovery.
A primary highlight of the study was the substantial reduction in opioid use, acknowledging that while these medications are effective for pain control, they pose risks—especially for children and teenagers. Beyond concerns about addiction, opioids can cause side effects like constipation, drowsiness, and slower recovery. To address this, the team employed alternative pain management techniques, including localized nerve blocks and the development of deep-breathing exercises and mindfulness strategies, recognizing the emotional challenges some patients face after surgery.
The research was conducted between 2019 and 2024, with hospitals gradually adopting the recovery program in phases, allowing comparison of outcomes before and after implementation. By the end of the trial, hospitals increased their use of the protocol’s steps from an average of 11 to 14 elements. The study also found that hospitals with strong teamwork and better integration of the protocols into electronic medical records achieved the greatest improvements.
Raval mentioned that his team plans to expand the program beyond gastrointestinal surgeries and adapt many of the recovery strategies for younger children and even newborns undergoing operations.
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