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Archive May 2020 XXI, No. 5

New Thinking in Post-Op Pain Management

To move on from opioids, providers are tailoring varied regimens based on patients and procedures.

Joe Paone

Joe Paone


MONSTER BLOCKS Researchers are looking at ways to extend the analgesic effect of regional anesthesia for a full day or longer.

There’s no silver-bullet, one-size-fits-all replacement for opioids in the management of post-op pain, so clinicians are experimenting with various drugs and techniques, both old and new. In the process, they’re finding an expanded toolkit of pain management modalities to reduce pain more effectively by mixing and matching tools for maximum effectiveness for individual patients and specific procedures. Here are some recent and emerging approaches to reducing both pain and opioid use:

  • IV acetaminophen. Its onset is very predictable and quick, acting within five to 10 minutes, according to Ronen Shechter, MD, an assistant professor of anesthesiology at Johns Hopkins University in Baltimore and co-medical director of its Perioperative Pain Program (PPP). “It’s faster to use, especially in quick turnover places, where you want to know the pain is controlled so patients can be discharged,” he says. “The problem is it’s significantly more expensive than the pills.”
  • Ketamine. Dr. Schechter says this old anti-inflammatory drug has been shown to reduce opioid consumption by 30% to 45%. “It acts on many receptors, many locations, and is very effective,” says Dr. Schechter, who uses it frequently in inpatient surgeries. “It can reverse some of the side effects of opioids, like hyperalgesia. Patients wake up very nicely with it.” It might not be ideal for outpatient centers craving quick turnover, though. “If it’s used too long or too much, the patient may have lingering sedation,” says Dr. Schechter, characterizing it as a drug that should be employed for very painful procedures or for patients with high opioid tolerance.
  • IV lidocaine. Another medication commonly used in inpatient procedures, this also has sedative properties. “It’s very effective as an analgesic, but the recovery is much slower,” says Dr. Schechter.
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