Orthopedic surgeons wielding their scalpels and laparoscopic tools during life changing surgeries understand all too well that pain is an unavoidable part of the healing process. Yet the current opioid crisis has influenced the orthopedics team at CMC to reevaluate their standard treatments and prescribing practices and implement new best practices for the safety and recovery of their patients.
“We now have a hospital initiative to try and decrease our narcotic usage because of the opioid crisis,” said Dr. Tyler Noble with OrthoSC. “It’s really become one of our initiatives recently, within 2019.”
Hip and knee replacement surgeries are some of the most common orthopedic procedures, and opioids have been a common pain medication used post-surgery. Yet, orthopedic surgery has come a long way allowing for new innovative methods to deal with post-surgical pain.
“Ten years ago, it was not uncommon for patients to stay in the hospital for two weeks after a joint replacement. They used to be able to self-medicate using a button to deliver an incredibly potent painkiller. Then, after that, we went to just doing the oral medications, like oxycodone and hydrocodone, but then as we found out we can do other things, we now do different injectables of medications and use nerve modifying medications like Lyrica or Gabapentin,” Noble said. “That kind of hits pain from all sorts of different angles, so we’re not relying on these really hard, sometimes behavior-modifying medications.”
There has been a trend where patients expect narcotics following joint replacement surgery, but through education, patients are realizing that there are other options for pain management and prescription narcotics are not always the answer. The CMC orthopedic team and surgeons are devoted to reassuring patients, evaluating them on their individual needs, educating them and providing clear expectations prior to surgery.
So, what can patients expect?
“Joint replacement is a major surgery. It’s going to be uncomfortable,” said Dr. Noble. “We use Tramadol or Ultram that are opioid-like, but they don’t have a lot of the same side effects. What we find is that a lot of patients in the early part of recovery, just taking a couple of those medications from time to time is good. Honestly, after that, a lot of patients will transition to just over-the-counter Tylenol. There are also other medications that we use that kind of work more on the nerve pathway that help change the way the body perceives pain, which are helpful.”
Although a lot has changed when it comes to post-operative pain management, narcotic medications are still an option to facilitate a patient’s health recovery.
“You know, we will do what we can to keep you comfortable, and if you need those narcotic medications, it is safe to do so,” said Dr. Noble. “No patient is going to want to have surgery if they feel like we aren’t going to control their pain. That is not the message we’re trying to send people. The message is that we are doing our best job to be good stewards to help with the opioid crisis and to give you a great post-operative experience, and if that’s able to be done without the use of these hard, sometimes dangerous, narcotic medications, then great. We don’t want you to be miserable. There are other options and narcotic medications are still one of them.”