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Opioid Alternatives in the Operating Room

Table of Contents

ICU - intensive care unit operating room with medical equipment setup.

Why Use Opioid Alternatives?

One of the fastest ways people become addicted to opioids is when they’re given pain medication during and after surgery. For instance, during a painful surgical procedure, it has been standard practice to administer an IV with opioids and then provide the patient with a morphine pump when the surgery is over. However, as the addiction epidemic to opioids worsens, hospitals and medical staff are searching for alternatives to prevent dependency, addiction, and possible overdose later on.
 

Possible Approaches to Preventing Addiction

Many hospitals across the country, particularly on the East Coast, have found alternatives to treatment in order to avoid the use of opioids during and after surgery.  In fact, some patients have even requested other approaches because they’ve developed and recovered from an addiction and don’t want to go through it again. For instance, when Stuart Anders experienced an almost deadly car crash, he pleaded with emergency room medical staff not to give him painkillers. Anders explained, “I can’t lose what I’ve worked for”.  Apparently, Anders had been addicted to opioids in the past and didn’t want to relapse. To help patients like Anders and others, some hospitals are using alternative methods instead of immediately jumping to opioids.
 

Opioid alternative methods include:

  • Numbing: For some patients, numbing a certain body part is the key to keeping them from feeling the pain. By using ultrasound, doctors can make their way to a key nerve and numb it using a local anesthetic.
  • Multimodal Analgesia: Sometimes, one numbing agent won’t do the trick. Doctors may have to numb the pain from multiple directions, using not only nerve blocks but also spinal anesthesia and local anesthetics such as lidocaine. Multimodal analgesia simply means using multiple methods to numb the area that’s in pain.
  • Exparel: This medication is a long-lasting version of the numbing agent bupivacaine. The medication costs more than most painkillers. However, it lasts longer and has proven to be effective in preventing the need for opioids.
  • NSAIDs: Prescription-strength NSAIDs (Non-Steroidal Anti Inflammatory Drugs) can help manage pain. In fact, the use of these drugs to manage pain has greatly increased.  However, one reason why NSAIDs have not been used more often is that they have side effects.
  • Anti-Seizure Medication: Some anti-seizure medications, like Gabapentin, can help relax nerve pain.
  • Physical Therapy: In some cases, patients have the option to participate in physical therapy instead of having surgery at all. When a patient needs surgery, physical therapy can also help replace the use of opioids after surgery.
  • Others: In addition to the above, there are other opioid alternatives that doctors have found to work well, such as administering acetaminophen intravenously and muscle relaxants.

Sometimes, a combination of two or more of the above alternatives can help hospitals avoid using opioids and keep their patient safe for the long-term. In some cases, a low opioid dose might be administered right after surgery. Although it doesn’t have to be enough for the patient to continue that particular medication after going home.
 

Benefits to Pain Management Alternatives

Some of the benefits to using alternatives are obvious: fewer chances that someone might become addicted to opioids. However, there are other benefits as well:

  • fewer complications
  • less costs
  • ease of recovery from surgery
  • no side effects from opioids (typically nausea, vomiting and constipation)
  • in some cases, shorter hospital stays post-surgery
  • less experience of pain

 

Patients May Need to Ask for Opioid Alternatives

The opiate alternatives listed above are methods that some hospitals and doctors have begun to use in response to the opiate epidemic. The medical field recognizes that they can help prevent addiction by administering fewer opioids when possible. However, at this time, administering opioids is still standard practice for relieving pain.
If a person wants to avoid dependency upon opioids, especially after surgery, they may have to ask for an alternative option. As more and more research is being done on the dangers of administering opioids, particularly during and after surgery, hospitals may change their standard practice. For instance, one research study found that 6 percent of patients continued to use their pain medication for at least three months after surgery.
Perhaps at some point in the future, patients won’t need to ask for non-narcotic treatment. However, for now, if you ever find yourself in the emergency room, you may need to ask for opioid alternatives. In contrast, if you are admitted to one of the medical centers below you may be able to experience their new approaches to preventing addiction to opioids:

 

How can Doctors Help with Opioid Alternatives?
Opioid Alternatives | Waismann Method

Another way to continue to avoid opioids post-surgery is to continue to communicate with your primary doctor. Often, the doctor who performed surgery is not the same as your primary care physician. You may need to communicate your desire to avoid opioids to your general practitioner in addition to the hospital staff. Remember that you may innocently begin taking opioids for pain post-surgery but may become more vulnerable to developing a dependency, especially if you have one or more of the following:

  • a mental illness
  • history of addiction
  • history of chronic pain
  • the need to manage many sources of pain

Working with your doctor, preferably one that knows your medical history, may support finding opioid alternatives.
 

Do Your Own Research

If you know that you’re going to have surgery soon, explore options for non-narcotic treatment. There is significant information available online about surgical treatment, the effects of opioids, and possible opioid alternatives. With the information in mind, you and your doctor can develop a plan for avoiding the use of opioids and staying safe for the long-term. This might be particularly important for someone who has already battled an opioid addiction and who doesn’t want to experience a relapse. If you want to stay safe during and after a medical procedure, consider the suggestions provided above.

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