Home E-Weekly October 31, 2017

How Anesthesiologists Are Curbing the Opioid Epidemic

Published: October 30, 2017

GAMECHANING Research from Tampa-based anesthesiologists reports that opioid-free anesthesia not only reduces nausea and pain-sensitivity but also the chance of over-prescription and abuse afterward.

Going opioid-free could be the future of anesthesia. Presenting findings to the 2017 Anesthesiology Annual Meeting, a group of Tampa-based doctors and researchers say their studies promote opioid-free anesthesia not only as a viable option but a potentially more beneficial one, too.

To explore the alternatives, the group, led by David Samuels, MD, medical director of anesthesia at Select Physicians Surgery Center and medical director for TEAMHealth Anesthesia, examined 1,009 consecutives cases. All patients were treated by the same anesthesiologist — in this case, Dr. Samuels himself — with the same opioid-free approach. Where fentanyl might typically be used, these patients undergoing head and neck operations received different combinations of magnesium, ketamine, lidocaine and ketorolac, depending on the age and wellbeing of the patient. The results were generally positive among both patients and providers.

Only 11% of patients reported nausea following surgery, a number that's dwarfed by the usual 50-80% of nauseous patients after anesthesia. Furthermore, only 36% of patients requested pain medication in PACU, and these cases were mostly concentrated among certain operations like complex facials plastics and nasal/sinus surgeries. These 2 groups requested more nausea medication in the PACU, as well. These positive results suggest that anesthesiologists could lead the way in reducing the use of opioids and other addictive pain medications.

"Studies show that 1 in 15 patients who has surgery is still taking prescription opioids 90 days afterwards," says Enrico M. Camporesi, MD, another of the study's co-authors. The idea behind eliminating opioid use during anesthesia is not just to prevent nausea and other complications during and after surgery, but also to prevent over-prescription and abuse afterward. With the positive results of one study in hand, this group now plans to research that very question going forward, whether opioid-free surgery can reduce the later use and abuse of opioids.

Joe Madsen

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