Reducing Opioids after Surgery Benefits Patients, Communities

Overview

By Richard K. Freeman, MD, MBA

September 18, 2019

Article


Despite the increasing use of minimally invasive techniques such as video-assisted and robotic surgery, patients who undergo chest operations still experience pain as they recover. The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience.” Every individual will have a different pain threshold and response to surgery. The pain a patient experiences can vary greatly depending on many factors, including the specific procedure performed, the patient’s health prior to surgery, and his or her age. 

It is important to control a patient’s pain after chest surgery, not only for comfort, but also to prevent complications such as pneumonia, blood clots, and infection. Opioid medications (pills containing a narcotic) traditionally have been prescribed to treat pain after surgery.

However, opioid use after surgery is associated with increased risk of opioid dependence. It is estimated that 70% of people currently abusing opioids obtain their drugs from legally prescribed medication, often from relatives or friends. An estimated 116 people die each day from opioid overdoses in the United States.

This public health epidemic has caused cardiothoracic surgeons, anesthesiologists, pharmacists, and nurses to search for ways of controlling pain after chest surgery while minimizing the use of opioid medications. Combining medications that target different pathways of the body such as anti-inflammatory and neurologic medications with local and regional anesthetics has produced excellent results. In our practice, use of a postoperative pain management program has resulted in patients’ pain being well controlled and opioid use reduced by 70% in the majority of patients. In fact, this multimodality approach seems to be providing better pain control for the majority of patients when compared to the traditional opioid-focused treatment strategy. 

Reducing the amount of opioid pills prescribed at the time of hospital discharge also helps by preventing unused pills from being abused. In one recent study, 35% of patients reported never using any of the opioid medications that they were sent home with after surgery. Minimizing opioid use also reduces the significant side effects that these medications can create such as nausea, vomiting, constipation, and dizziness resulting in falls.

In addition, studies have shown that decreasing opioid use after chest surgery helps patients go home more quickly. This likely is because patients are up and moving early after surgery and experiencing fewer of the side effects attributed to opioid medications. Earlier discharge from the hospital also generally will result in a reduced total recovery time. 

In short, if you or someone you know is preparing for surgery, I encourage you to discuss an individualized pain management plan with your surgeon prior to the operation so that you can receive maximal pain control and the best recovery possible.

The opinions expressed in this article are those of the author and do not necessarily reflect the views of The Society of Thoracic Surgeons.