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Archive Opioids 2020

Planning for Proper Pain Management

Efforts to reduce patients' reliance on post-op opioids should begin before they show up for surgery.

Carrie Millsap

Carrie Millsap


Monterey (Calif.) Peninsula Surgery Center
TEACHABLE MOMENTS Surgeons at Monterey (Calif.) Peninsula Surgery Center give patients brochures about safe opioid use before their surgeries and answer any questions they have about opioid-sparing analgesia.

One of our facility's surgeons is well known for sending patients home after surgery with 3 opioid pills. That's it. His patients are initially surprised and wonder if that will be enough to relieve their pain, but it usually is. The surgeon makes sure patients have reasonable expectations about how they'll feel after surgery and assures them that the 3 pills will carry them through their recovery. He has a proven pain management plan, and sticks to it.

Many of our facility's other surgeons follow his lead, rarely prescribing more than a 5- to 7-day supply of painkillers. Their efforts are at the forefront of our facility's comprehensive approach to opioid-sparing patient care, which is very similar to the ones contained in the Safe Opioid Use Toolkit for ASCs distributed to members of the California Ambulatory Surgery Association (CASA) and ensures the painkillers are used effectively, appropriately and safely.

1. Educate and inform

Discuss with your patients what they should expect in terms of pain following their procedures and your facility's pain management protocols a week or two before surgery. They should know in advance, for example, that they'll experience a spike in pain on day 2 or 3 post-op when nerve blocks wear off. Explain the effectiveness of non-opioid alternative therapies and how they'll play a key role in minimizing the amount of opioids they will need to take. For example, acetaminophen and NSAIDs such as ibuprofen, naproxen and celecoxib are effective adjunct therapies that limit opioid consumption.

The opioids surgeons prescribe should be for the shortest duration possible — a 7-day supply is usually sufficient to manage pain after most surgeries — low-dose and short-acting. Also establish a default number of pills that are prescribed following specific procedures (see "Standardized Scripts for Every Surgery" here for more about recommended pill counts).

During pre-op consultations or assessments, share brochures and other educational materials with patients about safe opioid use. Remind them that your staff and surgeons are available at any point before and after their procedures to answer questions they have about your opioid-sparing protocols. Encourage patients to keep a pain diary. Jotting down notes about how they feel can help them better understand what treatments are working, and which aren't. Referencing those firsthand accounts of a patient's recovery during post-op clinic visits will help surgeons refine their pain management regimens.

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