The opioid crisis, which began in the mid to late 1990s, resulted from the development of and aggressive pharmaceutical marketing of an opioid pain medication, OxyContin. OxyContin's FDA approval in 1995 originally sparked hope, with pharmaceutical companies marketing it as a "minimally addictive" wonder drug. At the same time, we experienced a shift in our approach to pain management in the healthcare setting when the American Pain Society introduced the idea of pain as the “fifth vital sign” in 1996. Measuring and treating pain became a national standard, and also led to the inclusion of the patient's perceptions of their pain management in patient satisfaction evaluations. This resulted in a surge in opioid prescriptions across medical fields —including surgical services — and helped fuel an increase in opioid addiction among surgical patients.
Statistics
The statistics are staggering. From 1999 to 2021, nearly 645,000 Americans died from opioid overdoses, with prescription opioids implicated in over 30% of opioid overdose deaths each year. In 2021, there was an average of 220 deaths per day due to opioid overdoses. And, the cost to our healthcare and legal systems is astronomical with an average price tag of 78.5 billion dollars. All of this underscores the urgent need to curb unnecessary opioid use in all aspects of care, including surgery.
Recognizing that surgery itself could inadvertently lead patients toward addiction, the medical community began exploring ways to manage post-surgical pain with fewer opioids, ultimately implementing evidence-based techniques, procedures, and pathways that helped us treat our patients holistically, prioritizing patient safety and recovery.
Transforming Surgical Pain Management with Regional Anesthesia
Enhanced Recovery After Surgery (ERAS) protocols have become a cornerstone in moving surgical care toward opioid-sparing, evidence-based approaches. ERAS encourages multimodal, opioid-sparing strategies that reduce the body’s stress response to surgery, which helps patients return more quickly to their preoperative functional state.
A central part of opioid sparing surgical care is regional anesthesia, or nerve blocks. Nerve blocks play an important role in ERAS pathways by providing effective, targeted pain relief, reducing the need for opioids both intraoperatively and postoperatively.
Remember, blocks aren't just for pain relief after the case, although that is certainly an important function. Nerve blocks relieve pain at the source, allowing patients to need less medication, less anesthesia, and most importantly, less opioids - during the case and during recovery. When a patient has a nerve block, the block does the heavy lifting for pain control, which reduces the body's stress response to the surgery, allowing the body to begin healing, without adding the stress of pain.
The first few hours after surgery are crucial for healing, and we want our patient's focused on healing, not on hurting. Nerve blocks allow that to happen without the use of opioids.
The Benefits of Regional Anesthesia for Patients
Regional anesthesia techniques have transformed pain management in surgical care, offering clear advantages over traditional methods:
Reduced Pain and Medication Use: With nerve blocks, patients experience a high level of pain relief without needing systemic opioids. Remember, exposure to high levels of opioids can lead to nausea, vomiting, decreased respiratory function, decreased bowel motility, and constipation. All of these side effects can influence morbidity and mortality for our patients, and exposure to opioids can increase risk of dependence and addiction.
Enhanced Recovery: Nerve blocks alleviate pain effectively, often leading to faster recovery, earlier ambulation, and shorter hospital stays.
Improved Surgical Outcomes: Patients managed with nerve blocks typically have fewer post-operative complications and a lower likelihood of readmission, supporting quicker return to daily activities.
Ultrasound-guided regional anesthesia (UGRA), which involves using ultrasound to precisely locate and administer nerve blocks, has made these techniques even more effective. UGRA results in longer block durations, faster onset times, and reduced opioid consumption—enabling surgeons and anesthesiologists to deliver tailored, high-precision pain management.
Opioid-Sparing Options in ERAS Pathways: What This Means for Patient Care
As regional anesthesia becomes more integrated into ERAS pathways, hospitals are experiencing a rise in opioid-free surgeries, enabling many patients to leave the hospital without any opioid prescriptions at all. This opioid-sparing approach provides a safer, sustainable option for managing post-surgical pain and is an essential tool in the fight against the opioid epidemic. ERAS pathways contribute to cost savings of up to $7,129 per patient due to reduced complications, fewer readmissions, and shorter lengths of stay, making them beneficial both economically and medically.
Regional anesthesia has proven to be a valuable addition to modern surgical care. By using nerve blocks to address pain preemptively, we’re giving our patients the best chance at a comfortable recovery, free from the potential pitfalls of opioid reliance. With every surgery that includes opioid-sparing options, we take one more step toward protecting our patients from the risks of opioid dependency, helping to build a safer future in pain management and surgical recovery.
With all of this in mind, I want to ask you a couple of questions...
When surgeons get impatient or they're running behind, and they don't want to wait for the patient to get a block before the procedure, do you think that's in the best interest of the patient? Even if they say they'll do the block after the case, what about all of the benefits to the patient during the case if they received their nerve block before the case started?
Awareness, understanding, and advocacy are the keys to ensuring the best surgical experience for our patients. So don't stop the block.
Until next time,
Melanie
P.S. You can learn more about regional anesthesia in this interview we did with Theresa Bowling: Going Beyond Opioids: Discovering the Power of Regional Anesthesia
P.P.S. There's a great book out there called Empire of Pain: The Secret History of the Sackler Dynasty written by Patrick Radden Keefe. If you want to learn more about the opioid crisis, I highly recommend this book. Also, the link I shared is an affiliate link. There's no increased cost to you for purchasing through this link, but it does help support First Case!
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