As soon as it became apparent that common surgical procedures could become inadvertent pathways to opioid dependence, surgeon Paul Sethi, M.D., and a team of colleagues at Orthopaedic & 
Neurosurgery Specialists (ONS) began looking into ways to reduce that risk for patients.
With Dr. Sethi as lead researcher, the group of orthopedic surgeons conducted years-long research into opiate-sparing, post-surgical options through the non-profit, ONS Foundation for Education and Clinical Research (ONSF). Dr. Sethi is president of ONSF.
As a result of their study, the majority of ONS patients now are better able to tolerate pain following certain surgical procedures than in the past. ONS surgeons are writing far fewer opioid prescriptions, and, in many cases, no prescriptions for opiates at all.
“We know patients are concerned about post-surgical pain and there is also real apprehension about opioid use,” Dr. Sethi said. “We have been able to address their concerns by incorporating the newest and most comprehensive pain management techniques and non-opiate alternatives.”
Finding solutions for pain management
Dr. Sethi and his associates tested a pain-reducing intra-operative protocol that keeps the surgical area numb for the first few days following a procedure. They found that patients who received the new treatment reported lower pain scores, took fewer, if any, opioids to control pain and rarely asked for refills.
While this new mode of pain management is currently used in a number of ONS surgeries, Dr. Sethi’s initial study focused primarily on decreasing opioid consumption following arthroscopic rotator cuff repair, a procedure with a particularly painful period of recovery. He recently presented the research findings at the prestigious 2018 American Shoulder and Elbow Surgeons (ASES) meeting in Chicago, IL.
During the period of the study, he reported, patients who were administered a long lasting analgesic, liposomal buipivacaine, in addition to an interscalene block with bupivacaine (ISB), reported statistically and clinically lower pain scores than the control group who received the ISB alone. Patients who were given both compounds consumed 64 percent fewer opioids than the control group and 58 percent of the patients receiving the protocol had stopped taking opioids by post-surgical day 4, compared to on 15 percent of patients in the control group.
Moreover, none of the patients with the protocol requested a prescription refill during the five-day post-op period; 28 percent of the control group requested refills during the five-day span. This is particularly significant in limiting the risk of addiction. According to the Centers for Disease Control and Prevention (CDC), opiate use beyond five days, and prescription refills, directly increases the risk of developing an opiate dependence.
“We have found that we can keep our patients safe from the dangers of opioid addiction by using this new multimodal, opioid-minimizing pain management strategy,” Dr. Sethi noted.
Pain relief that’s safer for patients and others
While there isn’t any other data to indicate how many opioid pills patients should be given after rotator cuff surgery, the ONS research team determined that 25 oxycodone 5mg pills, at most, should be sufficient to manage the pain during surgical recovery. This is in sharp contrast to the current average amounts prescribed, which a recent report, Exposing a Silent Gateway to Persistent Opioid Use, found to be 93 pills.
Fewer opioids is not only good for the patient, it reduces the risk that unused pills, which are often improperly stored or disposed of, can fall into the hands of opioid abusers.
“Now that we are able to perform many opiate-free surgeries, our patients are much happier,” Dr. Sethi said.
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