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Reducing Opioid Use in Anesthesia

By Stephen M. Powell, MD, Facility Medical Director, Anesthesia, The Christ Hospital and Michael McReynolds, MD, Assistant Medical Director, Anesthesia, The Christ Hospital


For centuries, people have known about the beneficial effects of opioids, along with their side effects and addictive possibilities. In recent decades, healthcare providers began prescribing opioid medications at higher and higher rates, leading to widespread abuse of both prescription and non-prescription opioids. Because opioids can effectively treat acute pain, they have been used in surgical settings for decades; however, this utilization can lead to postsurgical misuse.

Persistent opioid use after surgery continues to affect millions of Americans. Each year, more than two million people may transition to continued opioid use following elective, ambulatory surgery. Nearly half of all U.S. opioid overdose deaths involve a prescription opioid. In addition, overprescribing of postsurgical opioids results in billions of unused pills. Reduced opioid use is a vital step in combatting this issue, but reduction alone will not end the epidemic.

Reducing the use of opioids is only half of the battle.

Education is a crucial piece of the puzzle. Patients and their families must understand the alternatives available to make their healing journey as comfortable as possible. As program directors, we are implementing a centralized perioperative surgical home that patients from all specialties will funnel through at The Christ Hospital in Cincinnati, Ohio.

Our teams are incorporating discussions regarding pain control, benefits of opioid reduction and alternative pain management approaches. The discussion starts at day one to align patient expectations and set the stage for what patients will experience in the perioperative period. It also helps patients and their support systems understand the care plan and provides education on our opioid-sparing pathway. This method seeks to reduce opioid usage, decrease healthcare costs and enhance patient experiences at The Christ Hospital. We are utilizing a collaborative approach to improve outcomes and ultimately reduce the need for opioids.

To reduce this use, we incorporate regional anesthesia techniques for all types of surgery – from nearly all orthopedic procedures to cardiac surgery. In orthopedics for example, we perform blocks for all total joint replacements, and spinal anesthesia is used whenever possible. Non-narcotic multi-modal pain medications are also used preoperatively to reduce the need for postoperative pain medications. Our surgeons also assist the non-narcotic approach by providing local anesthetic at the surgical site. These tactics mean all total joint replacement patients go home the same day with minimal narcotic usage.

Patients and hospitals benefit from pain management alternatives.

Our true focus is to improve patient experience and outcomes. We now see fewer complications, falls, readmissions, urinary issues, nausea and bowel obstructions. These are related to opioid use reduction, but the ultimate driver is the patient’s experience, which in turn, leads to an overall improvement of medical practice by improving patient satisfaction and outcomes.

TeamHealth’s Anesthesia program redefines high performance in the operating room. With our collaborative, evidence-based approach, we transform perioperative care to provide better clinical and patient experiences. That’s what makes us a great partner for anesthesia management. Get in touch with us today to learn more about partnering with us.