Curbing the Opioid Epidemic The role of ASCs and EHRs BY MAURA DENT CASH, RN

Emergency rooms (ER)— where a 2016 report in The New York Times says up to 75 percent of visits are for pain—can be a starting

point for addiction. Many patients’ initial exposure to opioids, however, is imme- diately following outpatient surgery. The continued use of opioids after the initial postoperative recov- ery period has increased greatly in recent years. Studies have shown that up to 10 percent of surgery patients given postoperative opioid medica- tions have continued opioid use after one year. We must do a better job of understanding the connection between the need for immediate postoperative pain relief and the long-term effects of overprescribing opioids and find the balance.

Timing of Opioid Administration Is Critical

If initial administration of opioids during and immediately after surgery is low, the post-discharge need for these types of pain meds decreases, according to a February 2016 study published in The Journal of Pain. The ASC community is already putting a lot of effort into reducing pain in the initial postoperative period. To facilitate a patient’s transition from the postop area to home without delay, they often use less long-acting anesthesia and fewer opioids during surgery and the immediate postopera- tive period than hospitals. Toward this end, I am seeing more and more ASCs using adjunct pain relief methods as a matter of routine. Instead of waiting for pain to start in the post-anesthesia

care unit (PACU), anesthesia provid- ers often give doses of acetaminophen IV and other non-opioid medications to certain surgery patients at the end of the procedure in the operating room. Having been at the forefront for find- ing alternatives, ASCs have used cre- ative ideas to combat pain because of the necessity for short stays and con- cerns for the safety of patients (i.e., not just loading them up with opioids and sending them out the door). ASCs also achieve effective anal- gesia using regional anesthesia tech- niques in conjunction with non-opi- oid therapies.

These postoperative pain blocks give patients immediate

pain relief that will wear off gradu- ally over several hours, decreasing the need for opioids in the immedi- ate postoperative period. Hospitals are less focused on these alternatives since patients will not be discharged home immediately postop. After surgery, a patient needs rest

to heal. Patients rest better and more comfortably in their homes, decreas- ing the need for pain medications. In the hospital, when the nurse enters the room—frequently just as patients have fallen asleep—to take vital signs and check IV fluids, they often ask, “Are you in any pain?” If patients say yes, they bring more medications.

The advice and opinions expressed in this column are those of the author and do not represent official Ambulatory Surgery Center Association policy or opinion. 20 ASC FOCUS FEBRUARY 2019 |

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