OPIOIDS AND ORTHOPEDICS

Written by Marilyn Westphal, BSN,RN, CNOR

Dr. Patrick Ebeling from Twin Cities Orthopedics spoke about the Opiod Crisis and his Orthopedic Practice. He specializes in foot and ankle surgeries and many of his procedures can be done under regional anesthesia blocks. However, he still has concerns about the Opiod Crisis in America. He discussed the history of Opiod use and looked at how we got to where we are today. Are there alternatives? He examined what he can do to change his practice and the role that the perioperative nurses play.

Opioid use dates back as far as the early 1800’s. Merck began marketing Morphine in 1824. Bayer released Heroin as a cough suppressant in 1898. In 1924 the FDA banned the sale of Heroin. It wasn’t until the late 1970’s that Vicodin and Percocet were approved in the US for marketing. From that point forward, opioid monotherapy dominated acute pain and post-operative pain management plans. There are many side effects and long term complications from opiod use.

What are the reasons for the crisis? Let’s start with….Doctors do a poor job prescribing them. They are extremely dangerous and patients do not discard them but rather “save” them or put them into the hands of others! There is also the concern for addiction if used greater than 5 days, the risk increases exponentially. Why do doctors prescribe so many? We want our patients to be pain free, satisfied, and not to be calling in for more medication. It can go as far as patient satisfaction scores and facility reimbursement.

Here are some staggering numbers to emphasize the situation that we are in. In 2016, 35,320 open carpal tunnel surgeries were performed. On average, patients had 18.5 pills left over after their surgery. This multiples to 655,186 pills that were not needed and unused annually. It is over a $3 billion dollar industry annually.

What has Dr. Ebeling done to modify his practice? He uses a multimodal approach of regional anesthestics, edema control, cryo therapy, NSAIDS, acetaminophen, neurolytics, NMDA antagonists, and Aplha-2 agonists. There are positive and negatives to every treatment plan. A multimodal approach requires patient and family engagement and education. The benefits are more choices for pain relief, less potential for abuse or addiction, and that you can attack the pain from different levels and angles. Unfortunately, this can be complicated and confusing for patients and their families so engagement is crucial. There can also be drug interactions/ limitations depending on patients medical history and / or allergies.

Dr. Ebeling has incorporated pain management teaching into his pre-operative clinic visit. He has a typed protocol and dosing schedule given to the patients in the office ahead of time. This information is reinforced in the pre-op and post-op areas with the family present by his Physician Assistant and the perioperative nurses. Finally, last but not least, educate patients and families on proper disposal of any used drugs.