Thomas Mark, MD, works as an anesthesiologist in the Department of Anesthesia at SUMMA Health System in Akron, Ohio. Dr. Mark recognized the need to transform the way pain was managed after surgery. Today, 80 percent of all hospital-wide cases are performed without the use of opioids to manage pain.
Giving opioid pain medication after most surgeries has been the standard approach for managing pain for decades. However, according to the Centers for Disease Control and Prevention, the rate of drug overdose deaths increased from 6.1 per 100,000 in 1999 to 21.7 in 2017.1 A large portion of these deaths were secondary to opioid use. Knowing that most people who become addicted to opioids begin with prescription drugs, Dr. Mark realized there was a need for opioid-free, post-operative pain management. Dr. Mark understood that with the use of techniques, like regional anesthetic blocks; liposomal bupivacaine for local anesthesia; and multimodal therapies including around-the-clock acetaminophen, non steroidal anti-inflammatory drugs (NSAIDs), and Neurontin, he could effectively and safely manage pain without opioids.
Understandably, there was resistance by physicians and staff members who doubted it was possible to manage pain and maintain patient comfort and satisfaction after significant and often complex surgical procedures without the use of opioids. Dr. Mark and his colleagues in anesthesia knew it was possible, so they went about proving so to the medical staff members and hospital administration.
An audit was performed on surgical patients who did not have the pain service follow them. In the cases where the surgeon took care of the pain control him/herself, Dr. Mark found that many high-risk patients in danger of respiratory complications were receiving IV opioids without appropriate monitoring of their respiratory status. He also found that the combination of acetaminophen and an NSAID, which is a standard recommendation by several national pain-management bodies, was only being given around 2 percent of the time if their pain service was not managing the patient. Dr. Mark met with the heads of general and orthopedic surgery to discuss these findings, as well as the high patient-satisfaction marks the pain service was receiving in the work of managing pain without opioids. When members of surgical services saw these data, they gladly enlisted Dr. Mark and his colleagues to assume control of managing pain after surgery in almost all cases.
Now that Dr. Mark and his team have shown they can manage post-operative surgical pain without opioids in a large and diverse population of patients, Dr. Mark and his team have started to address the needs of patients who have pain in the emergency room.
“This is a team effort,” Dr. Mark said. “All the doctors and certified registered nursing anesthetists I work with are invested in managing pain as much as is possible without the use of opioids. It really takes a team effort to make this kind of change in our culture.”
The biggest impediment in changing culture is the need for more education and physician ownership of new processes, according to Dr. Mark.
“We have to do a better job collaborating when it comes to pain management,” he added. “We know we can manage pain a good deal of time without exposing patients to the risks of opioids, and they all deserve that care.”
Source: Centers for Disease Control and Prevention. Drug Overdose Deaths. Available at: https://www.cdc.gov/nchs/data/databriefs/db329-h.pdf. Accessed on: June 4, 2019.
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