5 thoughts on non-opioid pain management in the ASC space

As the fight against opioid abuse continues across the nation, Anuj Gupta, MD, of Atlanta-based Peachtree Orthopedics, spoke with Becker's ASC Review about non-opioid pain management in the surgery center space.

Question: What sort of non-opioid pain management alternatives are available for the surgery center space?

Anuj Gupta: Multimodal analgesia is used for a manner of outpatient procedures, including joint replacements. These include non-opioid options such as acetaminophen, nonsteroidal anti-inflammatory drugs and anticonvulsants. Additionally, regional anesthetic techniques have been highly effective in decreasing the need for opioids.  

Specifically, for total knees, adductor canal blocks using pumps and  indwelling catheters, such as the ON-Q* Pain Relief System, a non-opioid elastomeric pump that continuously delivers a local anesthetic to a patient’s surgical site area or peripheral nerve, have markedly decreased the need for opioid analgesics.

Q: What are the challenges of capturing accurate postoperative pain scores following outpatient total joint replacement surgery?

AG: In the outpatient setting, the patient is not able to directly report their pain level to the provider and their recollection of their pain may not be accurate by the time of their first postoperative visit. ON-Q* TRAC, an online patient engagement platform, allows the patient to report his or her pain in real time and in an accurate manner. This data is transmitted to the provider and becomes actionable.

Q: What aren't surgery centers and outpatient surgery center personnel talking about when it comes to pain management that they should be?

AG: The migration of surgical procedures from the high-cost inpatient environment to the lower-cost outpatient environment is taking place. Most physicians and surgery centers are slow adopters of new pain management techniques and technologies that help to make this happen. For example, ON-Q helps reduce the need for opioids, which reduces many opioid-related side effects and helps patients recover faster after surgery with less pain.  

Although these conversations are starting to take place, the transition is taking place very slowly.

Q: Concerning opioids, why do they continue to dominate their share of the market? Will there ever be a time that opioids are eliminated?

AG: Opioids have been the primary tool for pain management over decades. As these newer techniques for pain management continue to evolve and improve, the need for opioids will continue to diminish. I do not know if we will get to a point where they will not be required, but I do believe that we will get to a point where they have a far less significant role.

Q: What is one takeaway on non-opioid pain management?

AG: Most of us recognize that the side effects associated with opioids are very clinically significant. Pain management is a key component of effective surgical treatment, especially in the outpatient environment. Although surgical techniques have improved in the area of joint replacement surgery, the single greatest tool that has allowed the migration to the outpatient arena has been advances in pain management. Patients are now able to walk very shortly after joint replacement, and length of stay is measured in hours, not days.

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