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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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and anesthesiology. Surgical professionals are often slow to adapt and with the stigma surrounding opioids today, many providers don't screen for opioid use disorder. Ideally, surgeons should screen patients during initial clinic visits, and alert surgical facilities and anesthesia teams when surgeries are scheduled for patients with the disorder. Given the difficulties the disorder can cause, these patients should be assessed by your anesthe- sia team, and their care should be coordinated among the surgeon, anesthesia provider and an addictionologist before they arrive on the day of surgery. That way, there will already be a plan in place for managing patients' pain in the facility and when they go home after surgery. When a patient with opioid use disorder is sched- uled for surgery, set up a group consult with their surgeon, addictionologist and anesthesia provider to develop an individual care plan. It's not uncommon for a patient with opioid use disorder to show up for surgery with the care team having no advanced warning of their condition. Likewise, the patient's addictionologist often has no idea the patient is going to be having surgery, or does not provide rec- ommendations for holding or continuing their med- ication-assisted therapy during this time. Improved communication among members of the care team well before scheduled surgeries will ensure these patients receive the extra attention they need. Rely on regional anesthesia There are two separate issues that need to be considered when caring for patients with opioid use disorder: intra- and post-op pain management. Traditionally, opioids have been used during both phases of care. Medication-assisted therapies for opioid use disorder make opioids ineffective for the treatment of surgical pain and cause patients' nerv- ous systems to feel pain more strongly. It's easy to manage their pain during surgery with strong medications such as ketamine, dexme- detomidine, magnesium, lidocaine infusions and esmolol, which have been shown to be very effec- tive intraoperative options. Problems can arise after surgery, however, because many of these medica- tions have unpleasant side effects and are only available in IV form, which limits the practicality of using them outside of the OR. Peripheral nerve blocks are one effective option for post-op pain management. Consider placing blocks during procedures, which is not a common practice. Additionally, instead of administering a single injection of medication for a peripheral nerve block that will last 12 to 24 hours, consider placing a continuous neve block and catheter, and sending patients home with a pain pump that will infuse analgesic medications for three to five days. Deserving of more Take the time and make the effort to deliver the appropriate care to these patients. Treating them in the same manner as opioid naïve patients subjects them to inadequate pain management and increases their risk of relapse. Optimize their pain manage- ment with peripheral nerve blocks and multimodal medications. Anticipate a delayed discharge from PACU from needing to spend additional time con- trolling their pain or teaching and reinforcing their post-op pain management strategies. Pain is a complex phenomenon and most health- care providers are woefully under-educated on how it works and how to address it. They often treat post-op pain with opioids because that's all they have been taught to do. Patients with opioid use dis- order are at high risk of relapse and uncontrolled pain after surgery. Opioid-free anesthesia, peripheral nerve blocks and multimodal therapy are all neces- sary to manage their pain and minimize their chances of suffering a setback. These patients deserve to be treated in facilities capable of provid- ing a higher level of personalized care. OSM Mr. Baribeault (tom@goopioidfree.com) is the president of the Society for Opioid Free Anesthesia. 3 S E P T E M B E R 2 0 2 0 • O U T P A T I E N T S U R G E R Y . N E T • 1 7 It's ethically unsupportable to expose them to the drug of their addiction.

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