J U LY 2 0 1 7 O U T P A T I E N TS U R G E R Y. N E T 5 5
who are still unaware of alternative therapies — acetaminophen, IV NSAIDs,
local anesthetics and gabapentin — that reduce the amount of opioids patients
need. Physicians also tend to overprescribe opioids. They write scripts for 30 to
60 days of therapy when in reality most post-op pain improves after a week.
Many patients don't finish their full prescriptions and the extra pills are left in
medicine cabinets. That certainly contributes to the abuse potential.
Isn't prescribing opioids easier than multi-modal pain management?
That's true, to a degree. Physicians tend to overestimate how much pain
medicine patients need after surgery and don't want to be bothered by patients
complaining of discomfort. Instead of writing scripts for a week's worth of
pain pills and requiring the patient to call in for refills as needed, they
prescribe a longer regimen, regardless of whether it's needed.
Is the outpatient evolution helping to limit the use of opioids?
Absolutely. Providers must consider alternative non-opioid based therapies to
provide pain relief without risk of PONV and sleepiness, so patients are ready
for discharge hours after surgery. Several complex procedures are moving to
the ambulatory setting and more could follow if we continue to develop
analgesic options that don't cause significant side effects.
OSM
Dr. Gan (tong.gan@stonybrookmedicine.edu) is professor and chairman of the depart-
ment of anesthesiology at Stony Brook (N.Y.) University.