1 0 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • O C T O B E R 2 0 1 7
A Day of Surgeries and Zero Opioids
Will alternative pain management techniques go mainstream?
Y
ou hear so much nowadays about opi-
oid-free anesthesia, but how do you go
from Demerol and Dilaudid to Celebrex
and Cymbalta? Can you really manage your
patient's surgical pain with regional blocks and
beta blockers? How do you substitute keta-
mine, precedex or clonidine for fentanyl in the
OR, and NSAIDs for narcotics in PACU? How
do you not send patients home with a pre-
scription for (too many) painkillers?
The Society for Opioid Free Anesthesia (SOFA) is glad you asked. The
200-member fledgling group (goopioidfree.com) is educating anesthe-
sia providers and sponsoring research about opioid-free techniques,
spreading the word that patients will do just fine without opioids during
and after surgery.
"It was not my intention starting out to totally get rid of opioids from
my anesthetic practice," says SOFA's founder, Tom Baribeault, CRNA,
MSN, of Richmond, Ky. "I started looking at ways to limit opioids both
intraoperatively and post-operatively. As I added different drugs and
different techniques, the amount of opioids I was using got to be so
small, I started asking myself, 'Why am I still giving them?'"
The last opioid standing? Fentanyl. When he withheld the fairly sizable
dose of fentanyl he always gave in tandem with propofol, patients didn't
even miss it.
"What was shocking to me is that patients did even better when I
took out the fentanyl," says the 36-year-old Mr. Baribeault. "They had
less pain, less nausea and they breathed better. One of the big dangers
of opioids is that they depress a patient's drive to breathe. When com-
Editor's Page
Dan O'Connor
SOFA's founder, Tom Baribeault, CRNA, MSN
