Capnography

Managing Post-Surgical Pain with less Narcotics

By  Theresa Bowling, MD, chairman of the department of anesthesiology at Stamford Hospital

Going through surgery can be a nerve racking experience. However, the healing that begins in the hours and days following is also an important step on the road to recovery. The ability to carefully and effectively manage pain after an operation can reduce a patient’s hospital stay and get them back to normal activities more quickly.

Upon awaking after surgery, patients may experience pain around the surgical site. If postoperative pain is ineffectively managed it could potentially lead, in the long term, to poor wound healing, insomnia, pneumonia, pulmonary embolism or other conditions. In addition, postop pain may be a risk factor for the development of chronic pain. Preventing and/or relieving postop pain may help avoid these complications and improve a patient’s quality of life.

Opioids are frequently prescribed for pain relief following surgery. However, narcotics prescribed for short-term postoperative treatment may lead to regular long-term use. A recent study of nearly 400,000 surgical patients found that 10 percent of patients who were prescribed opioids within seven days of surgery were still using those medications one year later, placing patients at increased risk for drug-related harm.1 They also have several other side effects such as respiratory depression, sedation, nausea and vomiting, constipation and grogginess.

Clinicians often underestimate the incidence, severity and added healthcare costs from opioid-related adverse drug events following surgical procedures. A 2012 retrospective study found that opioid-related adverse events (ADEs) in surgical hospitalizations are all too common.2 Opioid-related ADEs occur in 19.4 percent of colorectal, hysterectomy and hip replacement surgeries, increasing length of stay by a full day.

Most patients aren’t aware that there are other options and narcotic alternatives available to treat post-surgical pain, such as ambulatory pain pumps filled with local anesthetic for regional anesthesia. The therapy can be used to manage pain for up to five days following surgery. A surgeon or anesthesiologist inserts a catheter near the surgical procedure area, either near the incision site or in close proximity to the nerves. The catheter is then connected to an infusion device filled with a local anesthetic medication. The steady flow of a local anesthetic blocks the pain at the source. The fact that these are now offered in an ambulatory device, means the patient can get up and walk around more freely and leave the hospital sooner. Because their pain is managed locally rather than with a lot of narcotics, they are able to reduce the risk of narcotic associated side effects.

It’s important for patients to know there are a variety of options for managing post-surgical pain so they can select the treatment that’s best for them. With innovative treatment solutions, such as ambulatory pain pumps that provide continuous regional pain management therapy, the recovery process can be made easier and less painful for surgical patients, and can help them return to regular activities more quickly with fewer side effects. For some pre- and post-surgical tips for patients, please click here.

1Alam A, et al. Long-term analgesic use of after low-risk surgery: a retrospective cohort study. Arch Intern Med. 172(5):425-430.

2 Gan T, Oderda G, Robinson S. Kidney injury after percutaneous and opioid-related adverse events increase length of stay and drive up total cost of care in a national database of

postsurgical patients. Presented at the 2012 Annual Meeting of the International Anesthesia Research Society (IARS). Boston, MA. May 2012.

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