Home E-Weekly February 13, 2018

ASA: It's Best to Limit Opioids or Avoid Them Altogether

Published: February 13, 2018

DON'T TAKE CHANCES Opioids are rarely needed for post-op pain and should be taken for no more than 3 days after surgery, says the ASA.

Most patients don't need any opioids at all after surgery — and those that do need only a few, not 50, for 1 or 2 days post-operatively, says the American Society of Anesthesiologists (ASA) in a new recommendation.

"Nobody needs a prescription for 30 or 50 opioids and even those who are in major pain and may benefit should only take them for a day or two," says ASA President James D. Grant, MD, MBA, FASA. "There are effective alternatives and many people don't need opioids at all or at least should drastically reduce the amount they take."

The ASA's recommendation comes as sentiment mounts that surgeons are unwittingly helping to fuel the opioid crisis by discharging patients with more highly addictive opioids — such as Vicodin, hydrocodone and oxycodone — than they need.

"Reducing opioid use during recovery after surgery is a big part of the solution" to the opioid crisis, says Dr. Grant. "Those who are in continued severe pain after surgery should ask a physician anesthesiologist or other pain specialist about other strategies to manage pain, including exercise, nerve blocks and non-opioid medications."

The ASA says ibuprofen and naproxen are often sufficient to manage post-op pain, adding that you should reserve opioids for extreme pain. Even then, prescribe a smaller number of pills that patients should only take for 1 to 2 days, 3 days at most, says the ASA.

ASA reminds you to manage patients' expectations, stressing that there's a difference between pain and soreness. "Think about when you have your teeth cleaned at the dentist or exercise particularly vigorously. You might be sore afterwards but you know it will pass, and wouldn't think of taking an opioid to manage the discomfort. You would likely turn to ibuprofen or naproxen to ease the soreness," says the ASA.

JoEllen McBride, PhD

InstaPoll: How Many Painkillers Do Patients Get? How many painkillers do you prescribe for the typical patient? Tell us in this week's InstaPoll.

Only about one-fourth (28%) of the 385 respondents to last week's poll start a case past 5 p.m. The results:

Your last case of the day typically starts at _____ .

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