A major clinical trial in the United States has found that a special recovery program for children undergoing gastrointestinal surgery can dramatically reduce opioid use and help young patients recover faster.
The study, led by researchers at Northwestern University and Ann & Robert H. Lurie Children’s Hospital of Chicago, showed that children treated with the recovery program used 56 percent fewer opioids while in hospital compared to those receiving standard care.
The results were published in JAMA Surgery.
The program includes 21 recovery steps designed to help children heal more smoothly before, during and after surgery.
Researchers call it an “enhanced recovery protocol.” The trial involved nearly 600 children and teenagers aged 10 to 18 from 18 pediatric hospitals across the country, making it one of the largest pediatric surgery studies ever conducted in the U.S.
Most of the children underwent surgery related to inflammatory bowel disease or other gastrointestinal conditions.
Some parts of the program begin before surgery even starts. For example, patients are allowed to drink clear liquids such as apple juice on the morning of surgery instead of fasting for long periods. During surgery, doctors try to use minimally invasive techniques whenever possible.
After surgery, patients are encouraged to start eating and walking earlier than usual. Doctors also try to reduce the use of tubes and drains and focus on pain treatments that rely less on opioid medications.
The researchers found that children who received at least 13 of the 21 recovery steps had much better outcomes. On average, they were able to start eating sooner, spent one less day in hospital and had about half the risk of complications compared to children who received fewer steps.
Lead author Mehul Raval said many of the program’s most important elements were inspired by feedback from patients and families. The goal was not only to reduce pain but also to reduce stress and anxiety during recovery.
Opioid reduction was one of the study’s most important findings. Opioid medications can help control pain after surgery, but they also carry risks, especially for children and teenagers. In addition to addiction concerns, opioids can cause constipation, sleepiness and other side effects that may slow recovery.
To reduce opioid use, doctors used other pain-control methods, including local nerve blocks that numb surgical areas. The team also developed deep-breathing videos and mindfulness strategies after learning that many patients struggled emotionally as well as physically after surgery.
The study took place between 2019 and 2024. Hospitals gradually introduced the recovery program in stages, allowing researchers to compare outcomes before and after implementation. By the final stage of the trial, hospitals had improved their use of the recovery steps from an average of 11 elements to 14.
Researchers also discovered that hospitals with strong teamwork and better integration of the protocols into electronic medical records had the greatest success.
Raval said his team is now expanding the program beyond gastrointestinal surgery and adapting many of the recovery strategies for younger children and even newborn babies undergoing surgery.
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