When a patient comes out of surgery, they will predictably be
in pain. As they recover, analgesics are the first thought to remedy the situation, but, due to the
side effects of opioids, surgeons
should be looking at how to help
patients manage pain without
opioids, or with less of them, Dr.
Stephen Cohen, an acute care
“Most surgeons throughout
the country are now treating postoperative pain with as little
amounts of opioids as possible, secondary to their addictive nature as well as a significant of opioids related adverse
events that not only prolong stay, but can cause major complications,” he explained. Complications can include, but
aren’t limited to, drowsiness, not being able to take deep
breaths, blood clots and pneumonia. “In general, these
side effects are typically mild and transient in nature, but
in some cases may require additional medications to treat
these side effects if they become intolerable,” Dr. David
Craig, a clinical pharmacist, elaborated.
Instead of relying solely on
opioids, Craig explained some
surgeons were prescribing alter-
natives, including non-steroidal
like ibuprofen or naproxen, acet-
aminophen and local anesthetics,
like lidocaine and bupivacaine.
“In many cases, non-opioid
analgesics can be as effective as
opioids, but, when opioids and
non-opioids are used together,
the combination can provide bet-
ter pain relief than either agent alone,” he said.
Cohen also has a similar mindset; for instance, he’ll use an
incision numbing cream, prescribe anti-inflammatory agents
and give them a smaller opioid prescription. “Instead of giving
someone a constant (opioid) pain medicine, they’re allowed
to have an opioid rescue,” he said. “We want to give as little as
possible to decrease the opioid related adverse events we see
on a daily basis on every patient who has surgery.”
Solutions to pain can even expand past pharmaceuti-
cals to more holistic methods, like massage, repositioning,
music therapy, relaxation training or guided imagery, Craig
suggested. “Using a combination of non-pharmacological
and pharmacological approaches to manage acute or post-
operative pain is likely to have better outcomes than either
strategy alone,” he said.
In addition to concerns for potential
side effects, Cohen indicated another
reason surgeons were turning away from
opioids was because of abuse. “It’s not
that we’re withholding the opioids,
because we think we’re going
to make them addicts.
After a few days or
weeks, we’ll stop
the medication,” he
said. “It’s (just) that
there’s so many more
addicts out there now.”
Opting Out of Opioids
Dr. Stephen Cohen,
acute care surgeon
Dr. David Craig, clinical
Surgeons say opioids aren't always the best option for patients.
by Rebecca Rudolph, editor
Although opioids have been a reliable pain medicine, surgeons are leaning away from them due to their side effects.