Outpatient Surgery Magazine

OR Excellence Awards - September 2020 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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M ore than 2 million Americans suffer from opioid-use disorder — and that might be a conservative estimate. This has led to a dramatic increase in patients presenting for surgery who are illicitly using opioids or in recovery from a problematic pattern of opioid use. Don't fall into the trap of treating these individuals like opioid naïve patients. Improving pain management protocols for patients with opioid use disorder will lead to vast improvements in the care they receive, save lives and protect the sobriety they have worked so hard to rebuild. Understand the risks Surgery is an especially stressful time for patients with opioid use disorder. They worry about the success of the procedure and complications from anesthesia like everyone else, but also face the risk of relapse from exposure to opioids given dur- ing or after surgery. In addition, opioid use disorder causes changes 1 6 • O U T P A T I E N T S U R G E R Y M A G A Z I N E • S E P T E M B E R 2 0 2 0 to the nervous system that make providing anes- thesia and managing pain particularly challenging. The American Psychiatric Society lists some of the symptoms of opioid use disorder as increased tol- erance to opioids and sensitivity to pain. Additionally, the standard treatment for opioid use disorder includes medication-assisted therapy, which includes buprenorphine/naloxone or nal- trexone. These medications block the opioid receptors and make using opioids to treat pain even less effective. It's clear opioids aren't effective at controlling pain in patients with opioid use disorder. It's also ethically unsupportable to expose them to the drug of their addiction without first exhausting all other efforts at controlling their pain. Improve communication Care of the patient with opioid use disorder is still a subjective area that must be guided by the best evidence of addictionology, pain management 1 2 Caring for Patients With Opioid Use Disorder Commit to the extra effort and attention needed to manage their post-pain. Anesthesia Alert Tom Baribeault, CRNA BETTER OPTION A judicious use of regional blocks is one effective way to avoid using opioids for these high-risk patients.

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