Rosa Kim asked
Does reducing preoperative IV narcotics result in less narcotic use postoperatively?
Answer
Pain management is one of the most critical parts of a
successful perioperative experience for patients. Some evidence actually
supports preoperative pain levels predicting postoperative pain levels.
Additionally, analgesics used prior to
the initiation of painful stimuli likely reduce postoperative pain and the
need for additional pain medications.
Therefore, preoperative treatment of pain, both opioid and non-opioid treatments, may actually reduce the need for further analgesics.
For many procedures, surgeons and anesthesiologists prefer to pre-treat the patients pain with opioid and/or non-opioid treatments. Pre-treating allows the medication time to take effect and may reduce the need for intraoperative and postoperative pain management.
The use of multimodal pain management has recently been
lauded for its ability to reduce the need for opioids in the perioperative setting.
For example, Enhanced Recovery After
Surgery (ERAS) protocols have been shown to reduce the length of
hospital stays (and associated costs), while reducing the risk of surgical
complications and improving patient satisfaction. Using a variety of non-opioid
pain medications can create a synergistic mechanism for treating the patient’s
pain.
Opioid Crisis or Shortage?
The nation is currently facing a significant opioid shortage, especially intravenous medications such as hydromorphone, fentanyl, remifentanil, hydromorphone, and ketamine. There are many factors that have contributed to the shortage with one being the DEA’s restriction of the active ingredients required to manufacture these important drugs.
Hospitals have had to make significant changes to their pain management protocols for all patients including perioperative treatment. One solution has been enhancing the use of oral medications and using multimodal treatments including acetaminophen, gabapentin, methocarbamol, and ketorolac.
The shortage has created an interesting paradox concerning opioids.
On one hand, there is an opioid crisis where thousands of people are dying
from opioid overdoses. Many more are addicted to opioids and the use of these drugs
is at an all-time high in the country. On the other hand, hospitals and
outpatient surgery centers are having to ration their supply of IV opioids and
the patients with the most need for opioids may not be getting the treatment
they truly need.
Summary
To conclude, preoperative pain management is crucial to consider
for reduction of intraoperative and postoperative use of opioids. The use of
multimodal pain medications can also play a role in reducing the patient’s
length of stay and improving associated outcomes.
