Operation Without Opioids: No Pain No Pills


MIAMI, Fla. (Ivanhoe Newswire) — The U.S. is in the middle of an opioid epidemic, but it might surprise you to learn that older Americans are most at-risk of dependence. A recent study found the number of seniors who misuse pain pills will have doubled between 2004 and 2020.  Now a new approach to managing pain after surgery is hoping to change that.

At the age of 88, Marvin Wiener still enjoys a good game of golf.

Wiener said, “it’s a very good challenge, it’s outside.”

But Wiener’s swing stopped when he needed shoulder replacement surgery. Like most patients, he worried about pain after the operation. Orthopedic surgeon Vani Sabesan, MD, at Cleveland Clinic Florida says that chronic pain can lead to opioid dependence in the elderly population. That’s why she’s changing the patient-doctor approach to surgery at Cleveland Clinic Florida.

(Read Full Interview)

“I think opioids are not the only way, they’re honestly probably not the best mechanism, to treat patient’s pain,” Dr. Sabesan said.

Instead, she educates the patient beforehand about the opioid crisis. Then she provides alternatives that minimize pain starting in the OR.

“We do a block where we put local anesthetic around your nerves and that is effective in providing pain relief for the first 12 to 24 hours,” Dr. Sabesan said.

Patients are encouraged to ice the area and take anti-inflammatory medications.

“I’ve had 40 patients, who’ve had a shoulder replacement, a rotator cuff surgery, and they’ve not taken a narcotic medication after surgery,” said Dr. Sabesan.

Follow-ups found those patients had better function after their operation. Wiener shocked his doctors when he was asked to describe his pain level.

“They were somewhat surprised when I said zero a few days after surgery,” said Wiener.

Now he’s back to the links and enjoying life to the fullest.

Dr. Sabesan is hoping this new approach to managing pain will become a global standard of care. She also recommends early rehabilitation to patients after surgery to get the joints moving.

Contributors to this news report include: Janna Ross, Field Producer; Judy Reich, Videographer; Cyndy McGrath, Supervising Producer; Hayley Hudson, Assistant Producer; Roque Correa, Editor.

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REPORT:       MB #4506

 BACKGROUND: On average, 115 Americans die every day from an opioid overdose. A particularly difficult aspect of this crisis is the use of opioids among surgical patients. Approximately 51 million Americans undergo inpatient surgery annually, and opioids remain a primary modality for postoperative acute pain management. Over 80 percent of patients receive opioids after low-risk surgery, and over 80 percent of these prescriptions involve oxycodone or hydrocodone. The adverse effects of prescription opioids are well documented. The presence of tolerance and physical dependence can occur even at prescribed doses.

(Source: https://www.cdc.gov/drugoverdose/epidemic/index.html & https://journals.lww.com/anesthesia-analgesia/Fulltext/2017/11000/Chronic_Opioid_Use_After_Surgery___Implications.40.aspx)

OPIOIDS: Opioids prescribed during and after surgery may trigger long-term use in patients regardless of whether or not they are opioid tolerant, taking opioids regularly before surgery, or ever been exposed to opioids in the past. Even opioids prescribed for low-pain, outpatient, or short-stay surgeries increase the risk of persistent opioid use, and over 60 percent of people receiving 90 days of continuous opioid therapy remain on opioids years later. Patients receiving an opioid prescription after short-stay surgeries have a 44 percent increased risk of long-term opioid use. Even prescribing opioids at hospital discharge to previously opioid-naive patients is a risk factor for chronic opioid use one year after discharge.

(Source: https://journals.lww.com/anesthesia-analgesia/Fulltext/2017/11000/Chronic_Opioid_Use_After_Surgery___Implications.40.aspx)

NEW RESEARCH: In a Cleveland clinic article by Vani Sabesan, MD, an orthopedic surgeon at Cleveland Clinic Florida, she explains, “One option for non-narcotic extended postoperative pain management is continuous interscalene nerve blocks (CISB). These have many advantages, but associated risks have led to exploration of alternatives, such as long-acting liposomal bupivacaine (LB). This agent has gained popularity for its potential to provide extended postoperative pain relief with fewer side effects. We performed a prospective, randomized clinical trial to assess the efficacy of LB, and found significant reduction in opioid use at 18-24 hours after surgery. The LB group had equivalent narcotic usage, pain scores and time to first narcotic rescue compared to the gold standard CISB group, but with fewer complications and cost, demonstrating that LB provides an excellent option for postoperative pain relief for shoulder arthroplasty patients.”

(Source: https://consultqd.clevelandclinic.org/managing-postoperative-pain-in-the-orthopaedic-patient-without-opioids/)


Arlene Allen-Mitchell, PR Cleveland Clinic Florida



If this story or any other Ivanhoe story has impacted your life or prompted you or someone you know to seek or change treatments, please let us know by contacting Marjorie Bekaert Thomas at mthomas@ivanhoe.com

Doctor Q and A

Read the entire Doctor Q&A for Vani Sabesan, MD, an Orthopedic Surgeon in the Levitz Department of Orthopedic Surgery

Read the entire Q&A