Publication date: Feb 13, 2020
But as he and Campbell discussed how much pain he might feel after the surgery and how they’d manage it without an emphasis on opioids, he realized that it could happen to anyone – even him.
In a study of 68 patients who had surgery to repair torn meniscus cartilage in the knee, Campbell and colleagues -found no significant difference in pain control, satisfaction, and total 1-week opioid use” between patients prescribed 30 to 40 tablets of combo oxycodone-plus-acetaminophen pills and those with prescriptions for just 10 combo pills and a nonaddictive ibuprofen regime.
-All patients used only limited amounts of opioids to control postoperative pain, suggesting we are currently overprescribing opioids,” the researchers concluded.
Dr. Charla Fischer, a spine surgery expert and colleague of Campbell’s at NYU Langone’s orthopedics department (and no relation to Dane Fischer), said that most of the time when a person becomes addicted to opioids, it’s not a result of their own medical treatments.
It’s no longer standard practice at NYU Langone orthopedics to give patients opioid refills without seeing them first, which gives the doctors a chance to figure out why they’re asking for more – whether it’s due to ongoing pain or because a patient is becoming dependent, and whether a treatment other than painkillers can help.
In early 2018, he spearheaded a 1,600-patient pilot program at the Cleveland Clinic’s Fairview Hospital, where doctors deliver over 5,000 babies a year, to test the impact on pain management of reducing the amount of opioids cesarean section patients received.
Patients in the pilot program got no opioid painkiller during surgery, and afterward received the maximum dose of Tylenol every six hours, along with some ibuprofen.
By mid-2019, C-section patients who did use opioids were discharged with around 12 pills, and by the end of the year that number was down to three to five pills.
If a patient hasn’t received opioids in the hospital, she’s sent home with no opioid prescription at all.
Nationally, around 6% of patients who are exposed to opioids for the first time during surgery become long-term users later on.
The Cleveland Clinic has now implemented the new C-section protocol across its entire system, and is now working to reduce opioids across all surgeries.
During an initial study involving 100 patients, Hedrick and colleagues soon discovered that it was possible to cut opioid consumption by 80% in favor of nonaddictive alternatives, without increasing patients’ discomfort.
According to a 2019 analysis of Medicare data by the Johns Hopkins School of Public Health and Kaiser Health News, from 2011 through 2016, thousands of surgeons sent patients home with prescriptions for dozens of opioid pills, sometimes more than 100, even for surgeries unlikely to cause much postoperative pain.
-Not only with C-sections, but with all surgeries, we’re treating with too much opioid pain medicine, and discharging with too much opioid pain medicine,” Chiang said.
- Opioid prescriptions affected by computer settings
- Opioid versus opioid-free analgesia after surgical discharge: protocol for a systematic review and meta-analysis.
- Comparison of Opioid Prescription Patterns and Consumption Following Otologic Surgery.