Please ensure Javascript is enabled for purposes of website accessibility
Efforts to Minimize Opioid Painkillers After Surgery Appear to Be Working
The-Conversation
By The Conversation
Published 6 years ago on
September 8, 2019

Share

The opioid epidemic has been wreaking misery and death across the nation for years. In 2017 alone, opioid overdoses killed more than 47,000 people10,000 more deaths than were caused by traffic accidents that year.


By Michael Kim
The Conversation

For many people who abuse opioids, the problem begins with opioid prescriptions from their doctors for pain relief. Government data show that 21%-29% of patients who are prescribed opioids go on to misuse them, and 8% to 12% develop an opioid abuse disorder. From 2016-2017, 800,000 people used heroin for the first time, according to the U.S. Department of Health and Human Services, with 80% starting with prescription drugs.
Many hospitals have begun to take steps to minimize the amount of opioids prescribed after surgery by managing pain through alternative methods. Research suggests that these programs can reduce the need for opioids after surgery and can reduce both post-surgical complications and the average length of hospital stay.
At Keck Medicine at the University of Southern California, I’m the director of our program to reduce opioid prescriptions and manage pain in other ways. I have spent the past year leading our enhanced recovery team to design and implement various pathways that have significantly reduced the opioid burden in our surgical patients. Here’s how these programs look in practice.

New Practices, Less Pain

Photo of a man eating in a hospital bed
Making sure that patients are hydrated after surgery is an important part of pain management. (Shutterstock)
We have modeled our program to manage pain after others that were developed originally to improve outcomes and shorten hospital stays after colorectal surgery. These programs, called Enhanced Recovery After Surgery, or ERAS, involve a range of measures, such as employing many different ways to reduce pain, and early mobility.
We have found that these protocols are easy to enact and can be as simple as giving the patients non-narcotic pain relievers in the days leading up to surgery to prep the body prior to surgery.
Some of the other methods include:

  • Ensuring the patients and their families have clear understanding and expectations about post-surgical pain management
  • Making sure a patient has plenty of fluids and carbohydrates Using a nerve block during surgery
  • Encouraging the patient to get up and walking within a day after surgery
  • Sending the patients home with no opioid prescriptions, or with a prescription for a very small number of pills

We have partnered with clinicians across the health care continuum. The process involves physicians, nurses, physical therapists, occupational therapists, case management, nutrition, pre-op management and social work.
While we have not yet published the results of our programs in an academic journal, I can say that these practices produced very tangible results; the post-operative opioid usage decreased by 50% in our division of thoracic surgery and by 60% in our department of urology.

A year after the University of Virginia implemented its ERAS protocol for patients undergoing thoracic surgery, it reduced the use of post-surgical morphine equivalents by more than half, reduced length of stay by two days, and even cut hospital operating costs.
The hospital’s division of cardiac surgery also reduced the use of post-operative opioid use by 45% for patients undergoing minimally invasive valve-replacement procedures. We anticipate publishing data on this finding as well. Some of our patients have gone through pre-op, surgery and post-operative care without the use of opioids at all and without any undue pain.
Other hospitals have reported success, too.
The University of Pittsburgh Medical Center cut the number of post-surgical opioid prescriptions in half.
A Cleveland Clinic pilot program to reduce opioid prescriptions in new mothers following Cesarean sections immediately reduced opioid use by two-thirds, and opioid-free hospital stays more than tripled.
A year after the University of Virginia implemented its ERAS protocol for patients undergoing thoracic surgery, it reduced the use of post-surgical morphine equivalents by more than half, reduced length of stay by two days, and even cut hospital operating costs.
These practices go beyond minimizing opioid prescriptions and can contribute to better overall patient care. For example, at Keck Medicine, our preliminary results show that we have been able to decrease the length of patient stay by up to 21% and have reduced complications from atrial fibrillation, or irregular heart beats that can lead to stroke, blood clots and heart failure, in thoracic surgery to less than 10%. We have also decreased intensive care stay for head and neck surgery by as much as one day. Also, we have cut by two days the length of time that catheters need to remain inserted into the bladders of post-operative urological patients. This is important because the risk of infection increases the longer a catheter remains inserted.

Advocating for Patients

Photo of a doctor talking with a patient
Consulting with patients before surgery can help them understand how to deal with post-surgical pain in different ways.
(Shutterstock)
An integral piece of the success is patient education. Most patients are so overwhelmed when they are about to undergo surgery and may be unaware that there are procedures to help limit opioid usage. And those who hear about opioid-minimizing practices may fear potential post-operative pain and may not consider that option.
It is important to educate patients well before their surgeries so they know their expected level of pain after their surgery and the different medication and procedures in place to minimize that post-operative pain. This kind of education is key in empowering patients to make informed decisions regarding opioids and their health.
About the Author 
Michael Kim, Clinical Assistant Professor of Anesthesiology, University of Southern California
This article is republished from The Conversation under a Creative Commons license. Read the original article.

DON'T MISS

What Are Fresno Real Estate Experts Predicting for 2025 and Beyond?

DON'T MISS

First California EV Mandates Hit Automakers This Year. Most Are Not Even Close

DON'T MISS

Yastrzemski and Chapman Homers Help Giants Rally Past the Brewers

DON'T MISS

Fresno City Council Finally Passes a Tough Smoke Shop Ordinance

DON'T MISS

Fresno Unified Trustee Wittrup Says District Had Stronger Candidates Than Misty Her

DON'T MISS

Trump Poised to Offer Saudi Arabia Over $100 Billion Arms Package, Sources Say

DON'T MISS

Lights, Camera, Board Vote: Fresno Unified’s Carefully Choreographed Production

DON'T MISS

US Farm Agency Withdraws Proposal Aimed at Lowering Salmonella Risks in Poultry

DON'T MISS

On Major Economic Decisions, Trump Blinks, and Then Blinks Again

DON'T MISS

Candi Is the Dandy to Add a Little Sweetness to Your Life

DON'T MISS

How Trump Tariffs Could Upend California Farms, Wine Businesses, and Ports

DON'T MISS

Tulare Man Sentenced to State Prison for DUI Crash That Injured Two Women

UP NEXT

RFK Jr Plans to Phase Out Artificial Dyes From the US Food Supply

UP NEXT

Baby Bonuses, Fertility Planning: Trump Aides Assess Ideas to Boost Birthrate

UP NEXT

UnitedHealth Spent $1.7 Million on Executive Security in 2024, Filing Shows

UP NEXT

US Supreme Court Appears Likely to Uphold Obamacare’s Preventive Care Coverage Mandate

UP NEXT

Steeply Discounted OD-Reversal Medicine Now Available to Any Californian

UP NEXT

Magic Happens When Kids and Adults Learn to Swim. Tragedy Can Strike if They Don’t.

UP NEXT

Spring Allergies Are Back. Here’s How to Check Pollen Levels and Keep From Sneezing

UP NEXT

Trump’s White House Launches COVID Website That Criticizes WHO, Fauci and Biden

UP NEXT

Texas Says Measles Cases Rise to 597 Since Late January

UP NEXT

Lilly Weight-Loss Pill Works as Well as Ozempic, Shares Surge

Trump Poised to Offer Saudi Arabia Over $100 Billion Arms Package, Sources Say

8 hours ago

Lights, Camera, Board Vote: Fresno Unified’s Carefully Choreographed Production

9 hours ago

US Farm Agency Withdraws Proposal Aimed at Lowering Salmonella Risks in Poultry

9 hours ago

On Major Economic Decisions, Trump Blinks, and Then Blinks Again

9 hours ago

Candi Is the Dandy to Add a Little Sweetness to Your Life

10 hours ago

How Trump Tariffs Could Upend California Farms, Wine Businesses, and Ports

10 hours ago

Tulare Man Sentenced to State Prison for DUI Crash That Injured Two Women

11 hours ago

Judge Partly Blocks Trump Order Seeking to Overhaul US Elections

11 hours ago

Two From Search Group That Uncovered Mexico’s ‘Ranch of Horror’ Killed

11 hours ago

US Warns States They Could Lose Transportation Funding Over Immigration, DEI Policies

12 hours ago

Yastrzemski and Chapman Homers Help Giants Rally Past the Brewers

SAN FRANCISCO — Mike Yastrzemski and Matt Chapman homered as the San Francisco Giants rallied to beat the Milwaukee Brewers 6-5 on Thursday ...

6 hours ago

6 hours ago

Yastrzemski and Chapman Homers Help Giants Rally Past the Brewers

6 hours ago

Fresno City Council Finally Passes a Tough Smoke Shop Ordinance

7 hours ago

Fresno Unified Trustee Wittrup Says District Had Stronger Candidates Than Misty Her

President Donald Trump delivers remarks during an 'Unleashing American Energy' event at the Department of Energy in Washington, U.S., June 29, 2017. (REUTERS File)
8 hours ago

Trump Poised to Offer Saudi Arabia Over $100 Billion Arms Package, Sources Say

9 hours ago

Lights, Camera, Board Vote: Fresno Unified’s Carefully Choreographed Production

Chickens sit at a poultry farm. March 12, 2025. (REUTERS/Diego Vara/File Photo)
9 hours ago

US Farm Agency Withdraws Proposal Aimed at Lowering Salmonella Risks in Poultry

9 hours ago

On Major Economic Decisions, Trump Blinks, and Then Blinks Again

Candi, GV Wire's Adoptable Cat of the Week
10 hours ago

Candi Is the Dandy to Add a Little Sweetness to Your Life

Help continue the work that gets you the news that matters most.

Search

Send this to a friend