Addressing the Opioid Epidemic – Opioid Free Anesthesia

Charles Trentham

Many opioid addicts trace the beginning of their addiction back to a hospital stay when they received opioids as an analgesic modality. With the opioid epidemic ravaging today’s world, it makes sense for anesthesia providers to consider anesthetic alternatives that lead to reduced or eliminated opioid usage. According to Mayo Clinic, as many as two million Americans have a prescription opioid use disorder, which is the medical term for addiction. Rather than contributing to this problem, anesthesiologists and CRNAs can help reverse it. At CCI Anesthesia, our anesthesia providers are empowered and trained to reduce opioid use wherever possible which can lead to better patient outcomes and higher satisfaction scores.

Rethinking Regional Anesthesia

The delivery of opioid free or opioid reduced anesthesia care is not limited to the postoperative period. Recruiting anesthesiologists and CRNAs who are skilled and proficient in delivering regional anesthesia care is paramount to the success of any departmental initiative to reduce opioid usage. Spinal anesthesia, epidural anesthesia and peripheral nerve blocks are important types of regional anesthesia that can make a tremendous impact on opioid reduction. If there are no medical contraindications, regional anesthesia techniques can be utilized for a variety of surgical procedures including:

  • Gastrointestinal/hepatic
  • Gynecology
  • Ophthalmology
  • Orthopedics
  • Thoracic
  • Urology
  • Vascular

Regional anesthesia, in many cases, leads to less time spent in PACU and faster recoveries. Since an increasing number of surgeries are being performed on an outpatient basis, this reduces the burden of pain management and weaning from opioids on patients and their families. Some facilities may need to invest in additional ultrasound equipment for anesthesia providers to use for ultrasound-guided regional anesthesia techniques.

Opioid-Free Anesthetic Agents

Choosing opioid-free anesthetic agents can be useful for opioid-naïve patients as well as for patients with chronic pain that is managed with opioids. Popular opioid-free anesthetic alternatives include concoctions of lidocaine, acetaminophen, dexmedetomidine, ketamine and ketorolac. Typically, there are minimal-to-no side effects from opioid-free anesthesia and postoperative pain can be managed with ibuprofen or Exparel.

Benefits of Avoiding Opioids

Considering that opioids have historically been given to patients intraoperatively, in the PACU, in the hospital as they recovered and at the time of discharge, there are numerous opportunities to reduce opioid use. Pursuing an aggressive, non-narcotic pain management protocol can lead to considerable decreases in length of stays, which leads to a reduction in hospital cost. The most rewarding aspects of reducing opioid usage revolve around patient outcomes. In addition to a dramatic reduction in postoperative nausea and vomiting (PONV), impaired gastrointestinal function, pruritus, urinary retention, delirium and the potential for developing an opioid addiction, patients receiving opioid free anesthesia are commonly able to recover without postoperative opioid consumption.

Implementing Opioid Free Anesthesia Techniques

The burgeoning concept of opioid free anesthesia, although becoming more widely accepted, is still lacking in scientific studies. Anesthesia providers who have made it a point to learn opioid free anesthesia techniques are early adopters of this science. There are certainly a large portion of anesthesia providers who are resistant to implementing opioid free anesthesia techniques due to lack of education on these skills. At CCI Anesthesia, we strive to educate our anesthesia providers on opioid free anesthesia techniques so that facilities wanting to implement opioid-reducing strategies are prepared to do so at every level of the patient care continuum.

If you are interested in learning more about how your facility can help fight the opioid crisis, contact us. We can assess your current anesthesia informatics to determine if there are missed opportunities for opioid reduction and make recommendations on opioid reducing strategies.

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