Aim <p>To construct an enhanced recovery after surgery (ERAS)-based nursing pathway for postoperative pain management in brain tumor patients and to evaluate its clinical efficacy.</p> Methods <p>This study was conducted in two phases. In the first phase (June 2022-December 2024), clinical data from 532 patients receiving brain tumor surgery were collected to analyze risk factors for moderate-to-severe postoperative pain (NRS score ≥ 4). A nursing pathway was developed by integrating the results of multivariate analysis with ERAS principles. In the second phase (January 2025-June 2025), 100 brain tumor patients were randomized to ERAS or control group (<i>n</i> = 50/group). Postoperative outcomes, including pain scores, daily analgesic consumption, functional recovery, hospital stay, complications, and nursing satisfaction, were compared.</p> Results <p>Multivariate analysis identified hypertension, preoperative headache, anxiety, depression, poor sleep quality, operative duration ≥ 6&#xa0;h, perioperative corticosteroid use, delayed first ambulation, and postoperative nausea and vomiting (PONV) within 24&#xa0;h as independent risk factors for moderate-to-severe pain. Compared to controls, the ERAS group demonstrated lower NRS scores on postoperative day 1/3/5 (<i>P</i> &lt; 0.01), reduced daily analgesic consumption and fewer rescue analgesia requests. Time to first ambulation occurred significantly earlier and hospital stay was shortened in the ERAS group. No statistical difference was observed in complication rates; however, nursing satisfaction was significantly higher in the ERAS group.</p> Conclusion <p>ERAS-based nursing pathway effectively alleviates postoperative pain, reduces analgesic requirements, accelerates recovery, and enhances satisfaction in brain tumor patients without increasing complication risks, demonstrating substantial clinical utility and potential for broader implementation.</p>