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Archive Opioids 2020

On Point: Give Patients What They Need

The judicious use of opioids provides appropriate post-op pain control.

Jay Horowitz

Jay Horowitz, CRNA


TARGETED APPROACH The evolution of versatile and accurate nerve blocks has contributed to opioid-sparing analgesic techniques.

Like many Americans, my life has been radically altered by the opioid crisis. More than a decade ago, a family member was prescribed 50 pills of OxyContin for a relatively minor knee injury. This was well before the current epidemic raised awareness of opioid misuse and abuse. My loved one was given (way!) more opioids than she needed, then manipulated the system to feed her ensuing addiction. I'm an anesthesia provider and still didn't see the warning signs.

Thankfully, my family member is on the road to recovery, but the emotional scars on us all remain. Statistics are compelling and important to consider as we judge the scope of the opioid addiction crisis and how to best address it, but don't lose sight of the fact that each number represents a struggling patient and friends and family members who face untold challenges. When a loved one suffers from addiction, the struggle impacts numerous lives, causing a widespread emotional and financial toll that you can't fully understand unless you live through it. Let's do what's necessary to improve how we manage perioperative pain, so others don't have to endure what my family has had to overcome.

Start by communicating with patients before the day of surgery to set reasonable expectations about how they'll feel after surgery and to educate them on how you'll manage their discomfort reasonably and safely. Patients need to understand that they will experience some pain after surgery, and that your team will do everything in their power to minimize it.

There are many alternative or adjuvant techniques available to help you reduce or even eliminate the use of opioids, from regional blocks to multimodal anesthesia protocols, which you'll read about on the following pages. Over the past decade, anesthesia providers have developed more versatile regional block techniques that have a greater chance of success thanks to the use of ultrasound-directed needle placements. We routinely use IV or PO acetaminophen, NSAIDs and gabapentinoids. We have developed enhanced pre-op protocols and post-op algorithms, which are encompassed in Enhanced Recovery After Anesthesia (ERAS) programs. We aren't as reliant on opioids at any phase of the perioperative period. More than ever, we work with other surgical team members to implement multimodal regimens that help us stay ahead of pain.

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