Safer options can reduce or replace opioid drug use after surgery.

By Lisa Esposito, Staff Writer, US News & World Report | June 8, 2018, at 12:23 p.m.

PHOTO CREDIT: Charles Wollertz; iStock / Getty Images Plus

Misuse is a possibility.

Recovering from major surgery is difficult. Incisions that cut through muscles, nerves, organs and bones make pain almost inevitable. Once the anesthesia wears off, opioid medications such as morphine, fentanyl, OxyContin and Percocet can make post-op pain more bearable. However, when patients leave the hospital still taking powerful pain pills – or when opioid drugs are routinely prescribed after outpatient surgeries – it’s not always safe. A massive study looked at more than 1 million surgical patients who hadn’t previously used opioids. After hospital discharge, of the nearly 570,000 patients who received opioids, each refill and each week of follow-up prescriptions was associated with a large increase in opioid misuse, according to the study published in January in BMJ. As the opioid crisis continues, experts say nonopioid alternatives should play a bigger role in treating post-surgical pain.

 

Ibuprofen and acetaminophen

Patients could manage pain on nonsteroidal anti-inflammatory drugs alone after certain procedures. NSAIDs such as ibuprofen (Motrin and Advil), acetaminophen (Tylenol) and naproxen (Aleve and Naprosyn) can work just as well, research suggests. A small, randomized controlled trial compared patients who received either opioids or NSAIDs after carpal tunnel surgery. Neither patients nor doctors knew which they received. No difference was seen in patients’ pain experience or the number of pills they consumed, according to the study presented at the annual meeting of the American Academy of Orthopaedic Surgeons in March. Among different types of surgery, including more complex and painful procedures, “It’s often these more common, high-volume, low-intensity surgeries are the ones that tend to result in dependency,” says study co-author Dr. Asif Ilyas, program director of the hand surgery fellowship at the Rothman Institute. He points to other, immediate advantages of avoiding opioids. Patients can bypass side effects such as drowsiness, nausea and voting, itching and constipation, and restrictions on driving or using heavy machinery.

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