Intermountain Healthcare First Health System in Utah to Offer Formal Opioid-Free Surgery Program For Patients Wanting Alternative Pain Control Options

SALT LAKE CITY, Feb. 27, 2020 /PRNewswire/ -- In an effort to minimize the use of narcotics after and during surgery, Intermountain Healthcare is the first health system in Utah to establish an opioid-free surgery program for patients seeking alternative pain control methods.

Intermountain surgeons and anesthesiologists developed protocols for the opioid-free surgical approach that will now be offered at Intermountain hospitals in Utah and Idaho for patients requesting the service.

The new program was tested for three months as part of a pilot project, in which physicians utilized non-addictive and less-addictive pain management alternatives for surgical patients looking for alternative pain control. The feedback from patients has been very positive.

"We've already used the new protocols for many procedures, from cranial surgeries, hernia repairs and hysterectomies to joint replacements," said Nathan Richards, MD, senior medical director for the Intermountain Healthcare surgical specialties clinical program. "It's important to know that this is an option for our patients. Patients who've opted for the non-narcotic approach in our pilot have been very pleased with the results, so it's a win-win for everyone."

During the pilot, Intermountain physicians used the new protocols in more than 250 surgeries. The results were positive. Patients reported overall lower pain levels. Other benefits included a reduction in the average length of hospital stays, a reduction in post-surgical complications, and a lower potential risk of opioid addiction.

Intermountain has made the reduction and appropriate use of opioids after surgery a top priority. In the past two years, Intermountain physicians have helped reduced the number of opioid tablets prescribed to patients with acute medical conditions by almost seven million, while increasing the number of alternative opioid-free pain control alternatives. Opioid-free surgeries are an extension of Intermountain's efforts.

Jason Zeeman, 45, from Payson, said the new Intermountain initiative for opioid-free surgeries was just what the doctor ordered.

After a motorcycle accident 19 years ago in which he broke his back, the heavy-duty diesel mechanic found himself addicted to opioids, at one point taking 120 Lortabs a week for pain control.

"It totally destroyed my life," said Zeeman.

But he said he did the work to successfully get through recovery, including going to counseling for 21 months and got his life back. When doctors discovered a hernia last November, he was nervous about receiving opioids during and after the surgery.

He said he was surprised to learn there was an opioid-free surgery option that he could choose. His surgeon and anesthesiologist explained in detail the new protocol, alleviating his fears of waking up scared, groggy, and lethargic from opioids.

Zeeman said he was in and out of surgery in 45 minutes and went home with the feeling of a tough abdominal workout instead of a pocket full of pills. He was back at work on light duty within five days.

Will Shakespeare, MD, Intermountain's medical director of surgical operations and director of anesthesiology, said research indicates pain prevention measures before surgery can also diminish the need for opioids and narcotic pain medications.

"If we can prevent the initial pain of surgery from progressing, then patients can have less pain overall," he said.

"Several procedures actually lend themselves to opioid-free surgery," added Dr. Shakespeare. "In some cases, such as heart surgery, opioid-free surgery wouldn't be an option. In all cases where opioid-free surgery is appropriate, it requires a willing surgeon and anesthesiologist, a compatible procedure, and above all a patient who wants an alternative approach and is motivated to follow an opioid-free operative course. It's definitely a team approach."

How the program works:

• Educate the patient and their families so they have a clear understanding of the risks of opioids and expectations about pain management post-surgery.
• Have a patient start taking Tylenol the night before they come in for surgery.
• When patients are in the preoperative area, give them a combination of non-narcotic medications, like another dose of Tylenol, an anti-inflammatory drug like Celebrex, and a nerve-modifying agent.
• Use regional anesthesia such as nerve blocks and/or spinal epidural anesthesia.
• Use non-opioid pain medicines such as Dexmedetomidine, Ketamine, Dexamethasone, Esmolol, and other agents that have been shown to decrease post-operative pain.
• Use long-acting anesthetics.
• Use a pain pump. This is where a catheter is placed at the affected nerve site during surgery. Patients then take the device home and when needed can pump medication directly into the painful area.
• Train patients in alternative pain management techniques, such as mindful breathing, focus management, and yoga exercises that can help them prepare for surgery and the recovery process.

There are patients who, for a variety of reasons, don't want to take any opioids when they have surgery. Some have had an addiction problem in the past or a family member who's struggled with such issues.

Other patients find opioids make them nauseous. Where appropriate, the new protocols will open the possibility of opioid-free procedures for these patients, if they choose this option.

"This is an ideal option for people who come in and say, 'I really don't want any opioids,'" Dr. Richards says. "Others may come in and say, 'I really think I don't want opioids, but I want to have the option to change my mind, if I want to.'"

Several studies have shown that people who've been using opioids to deal with chronic pain can be put on a treatment program that transitions them completely off opioids. Even those who've been on opioids for years have pain scores that statistically stay the same, but their quality of life improves.

These studies show those same patients have significantly increased mobility and can do more after they get off opioid medications.

"It means they can have a fuller and richer life because the pain doesn't feel like it's the only thing in their life anymore," Dr. Shakespeare said. "This is an exciting frontier for our patients and the Intermountain system."

SOURCE Intermountain Healthcare