Opioid-Free Alternatives to Managing Outpatient Surgery Pain

With America’s opioid crisis responsible for nearly 50,000 drug overdose deaths last year alone, many ASCs are looking for creative ways to manage post-op pain without prescribing habit-forming opioids. One Massachusetts-based surgeon, dubbed the "opioid-sparing orthopedic surgeon", says he’s found two effective alternatives for knee surgery patients.

Dr. Scott A. Sigman, a board-certified orthopedic surgeon with Orthopedic Surgical Associates of Lowell, says the road to opioid-free pain management has not been an easy one, but tenacity has helped him find a solution that is working well for his patients.

In a recent Outpatient Surgery article, he cited a patient who successfully underwent a total knee replacement without taking a single post-op narcotic pill. Instead, he used iovera cryotherapy treatment on the patient four days before operating and then administered an Exparel (bupivacaine liposome injectable suspension) field block on the day of the surgery.

Cryotherapy is so effective at helping Dr. Sigman manage pain because it temporarily freezes the axons in the sensory neurons. Those axons can take up to 6 to 8 weeks to redevelop, which gives the body time to recover from the initial pain of the surgery.

That, combined with the instant pain relief of Exparel at the time of surgery, offers the patient an effective cocktail of short and long-term pain management.

"We use saws and drills on a patient and it hurts like heck, but if you can get them to a softer landing through that first 3 days afterwards," Sigman tells Outpatient Surgery, "the pain is not as bad as it was when it first happened because all of the chemicals that create that pain stimulus are washed out of the system."

Regional nerve blocks, used in conjunction with continuous catheters and pain pumps, have also proven effective in helping patients manage the pain of outpatient surgery without the need for prescription opioids.

For certain outpatient surgeries, like primary unilateral carpal tunnel release (CTR), studies have found that even over-the-counter pain medication like ibuprofen or acetaminophen, can be as effective as oxycodone in helping patients. In one study involving 100 patients who underwent CTR with local anesthesia, some participants were blindly given 5 mg of oxycodone, a second group was given 600 mg of ibuprofen, and a third group was given 500 mg of acetaminophen.

Asif M. Ilyas, MD, FACS, the study’s author and the medical director at the Orthopaedic Surgery Center at Bryn Mawr Hospital reported, “There was no clinically significant difference in pain experience or pill consumption whether patients received an opioid or non-opioid after surgery.”

Ilyas also says adequately counseling patients about the addictive nature of opioids when prescribing them goes a long way in preventing their abuse. He asks his patients to watch a video prior to surgery.

"There was two-thirds less opioid use in those who were counseled," Dr. Ilyas reported. "We make them understand the pros and cons of opioids, what are the right ways and wrong ways to use them, and how long they should use them."

To learn more about the groundbreaking opioid-free strategies outpatient surgeons and anesthesiologists are using to help their patients, read the full Outpatient Surgery article.

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