Archive October 2017 XVIII, No. 10

Editor's Page: A Day of Surgeries and Zero Opioids

Will alternative pain management techniques go mainstream?

Dan O

Dan O'Connor, Editor-in-Chief


Tom Baribeault, CRNA, MSN SOFA's founder, Tom Baribeault, CRNA, MSN

You hear so much nowadays about opioid-free anesthesia, but how do you go from Demerol and Dilaudid to Celebrex and Cymbalta? Can you really manage your patient's surgical pain with regional blocks and beta blockers? How do you substitute ketamine, precedex or clonidine for fentanyl in the OR, and NSAIDs for narcotics in PACU? How do you not send patients home with a prescription for (too many) painkillers?

The Society for Opioid Free Anesthesia (SOFA) is glad you asked. The 200-member fledgling group ( is educating anesthesia providers and sponsoring research about opioid-free techniques, spreading the word that patients will do just fine without opioids during and after surgery.

"It was not my intention starting out to totally get rid of opioids from my anesthetic practice," says SOFA's founder, Tom Baribeault, CRNA, MSN, of Richmond, Ky. "I started looking at ways to limit opioids both intraoperatively and post-operatively. As I added different drugs and different techniques, the amount of opioids I was using got to be so small, I started asking myself, 'Why am I still giving them?'"

The last opioid standing? Fentanyl. When he withheld the fairly sizable dose of fentanyl he always gave in tandem with propofol, patients didn't even miss it.

"What was shocking to me is that patients did even better when I took out the fentanyl," says the 36-year-old Mr. Baribeault. "They had less pain, less nausea and they breathed better. One of the big dangers of opioids is that they depress a patient's drive to breathe. When combined with the sedative effects of anesthesia, that can create a dangerous situation."

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