Opioids are being used less with surgery — here’s what to expect for pain relief

Photo caption: Orthopedic hand surgeon Kanu Goyal, MD, performs a WALANT (wide-awake, local anesthesia, no tourniquet) procedure, one of many strategies The Ohio State University Wexner Medical Center uses to limit reliance on opioids during and after surgery while shortening recovery times and decreasing the risk of anesthesia side effects.

In the last two decades, the number of drug-involved overdose deaths has ballooned, according to the Centers for Disease Control and Prevention (CDC). Many of those overdoses can be attributed to opioids.

Unfortunately, some who developed opioid use disorder began taking opioid medication because their health care provider prescribed it as effective pain relief after surgery.

“Opioid use disorder (OUD) develops only after exposure to opioids, and we often see patients who were initially prescribed opioids for an injury or surgery, then go on to develop OUD,” says Julie Teater, MD, medical director for Addiction Medicine at The Ohio State University Wexner Medical Center.

That’s why many health care organizations, including the Ohio State Wexner Medical Center, are now committed to reducing opioid prescriptions and using pain relief methods that are less likely to create addiction.

“We know that risk factors include genetic factors, environmental factors and individual factors, and patients often have vulnerabilities for OUD and don’t know it,” Teater says. “For example, about 50% of the risk for developing OUD is genetic, but a person might not be aware of their genetic predisposition.”

By decreasing exposure to opioids, Teater says, health care providers decrease patients’ risk of developing OUD.

Here’s what these new opioid reduction methods mean for patients who need pain relief after surgery:

You’ll likely go home with fewer opioid pills, if any

Providers will do their best to prescribe just enough medication to manage pain effectively, says Michelle Humeidan, MD, medical director of Enhanced Surgical Recovery (ESR) at the Ohio State Wexner Medical Center.

“Our cornerstone goal in starting the ESR protocol at Ohio State in 2016 was to reduce the need for opioids after surgery,” Humeidan says.

Ohio State’s Toward Opioid-Free Ambulatory Surgery (TOFAS), a study currently investigating the effectiveness of pain management without opioids for same-day or ambulatory surgery patients, has found that prescribed opioids often weren’t needed.

The study found that, in patients undergoing hernia surgery who are discharged the day of the procedure, more than half of the opioid prescriptions weren’t being used. It creates an opportunity for addiction, whether it’s the patient continuing to use opioid medication beyond what they need, or someone else in their household or community accessing that person’s prescribed medication.

“Many patients are able to adequately manage pain after surgery with acetaminophen (Tylenol), ibuprofen or other non-opiate options,” Humeidan says, “with the option of a low-dose opioid for pain spikes.”