The opioid crisis continues to plague every community in the country, with the Centers for Disease Control and Prevention estimating that 91 Americans die daily from opioid-involved deaths. And with a new study suggesting that the number of deaths may be severely under-reported, it is clear that more needs to be done to help turn the tide of this epidemic. While it’s promising to see the White House focused on combating the issue, the medical community must do its part to reduce opioid prescribing and avoid unnecessary patient exposure when possible.
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As a board-certified OB-GYN at Moore County Hospital in Dumas, Texas, I am acutely aware of the role that physicians play in opioid overprescribing. In fact, a recent report found that 9 in 10 patients are exposed to opioids to manage pain after surgery, despite the availability of effective non-opioid options. Another study from JAMA found that more than two-thirds of patients have leftover opioids after surgery, resulting in a high number of pills available for possible diversion or misuse. We must do better. Although opioids are often viewed as the gold standard to treat post-surgical pain, utilizing opioid alternatives, including non-opioids, can help minimize or in some cases completely eliminate the need for opioids after surgeries like cesarean sections. By raising awareness and employing non-opioid strategies in our pain management protocols, we can help diminish the risk of opioid misuse or abuse among our patients.
I have seen the negative effects of opioid abuse firsthand, and I am truly committed to reducing opioid use for my patients. I utilize multimodal therapy, which manages pain by using a combination of non-opioid medications such as local analgesics, regional anesthesia and anti-inflammatories. For C-sections, I treat my patients with a long-lasting local analgesic called EXPAREL® (bupivacaine liposome injectable suspension), which I inject during surgery to provide patients with non-opioid pain relief for several days. Following surgery, my patients alternate only with acetaminophen and ibuprofen for a few days to treat any discomfort.
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Using non-opioid options also eliminates the risk of unpleasant side effects that often go hand-in-hand with opioid use, such as nausea, constipation and vomiting, enabling new mothers to recover quicker and allowing them to spend quality time with their newborn as soon as possible. Currently, in our hospital, elective C-section patients stay an average of 1.2 days. Meanwhile, the American College of Obstetrics and Gynecologists reports that most women who deliver via C-section typically stay in the hospital between two and four days. Additionally, most of my patients do not require any opioids during and after C-section deliveries. However, recent research found that 83 percent of patients used opioids for an average of eight days after discharge, and 75 percent still had unused pills. This non-opioid strategy has been better than any other protocol I have used in my 28 years as a surgeon. Because of its success, I have started utilizing EXPAREL with hysterectomy patients, who have also reported positive results with little to no need for opioids to manage pain.
It is critical that we recognize how effective these non-opioid options can be at improving patients’ recovery experiences after surgery. It is up to us as clinicians to change prescribing habits in order to offer our patients the highest standard of care.
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If patients are concerned about opioid use to treat post-surgical pain after a C-section or any other surgery, they should talk to their doctors to see if non-opioid options are available. Pain is different for everyone, but women should feel empowered to have these types of conversations with their physicians before delivery. The fight against the opioid epidemic is a long way from being over, but health care professionals can help mitigate the societal burden of opioid use by focusing on reducing opioid prescribing and advocating for the effective non-opioid options available.
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Eliminating the Need for Opioids in Cesarean Section Deliveries originally appeared on usnews.com
