By SARAH FAY CAMPBELL|Oct. 29, 2019 – 11:18 PM
Piedmont Healthcare is working to adequately manage patient pain while reducing the use of prescription opioids in hospitals across its system, including in Newnan.
The newest protocol at Piedmont Newnan is called “Enhanced Recovery After Surgery” and uses several steps – including one rather unconventional one – to reduce the need for opioids in surgical cases.
The new surgery protocol is a multimodal, multidisciplinary, evidence-based approach to the care of patients before, during and after surgery. Updated guidelines are published periodically by the ERAS Society, based in Sweden.
“It really uses a multimodal approach to pain management, so it’s more than just opioids or even just medications,” Copelan said.
It’s not just about reducing opioids, though that is definitely part of it. “It is really about optimizing their pain management,” Copelan said.
Opioids only work on one type of pain receptor.
“If all we use is opioids to manage your pain, we are only attacking it from one approach,” Copelan said. “We have a better chance of managing their pain if we approach it from several directions instead of just one.”
The ERAS protocol starts with a high-carb sports drink, which patients take before they are put under anesthesia.
When surgery is scheduled, patients have to fast for an extended period of time so that their stomachs are empty when they are put under. The anesthesiologists are able to manage the sports drink, which is administered at just the right time, Copelan said.
The drink helps patients’ blood sugar keep from going too low during surgery and immediate recovery.
“It helps your recovery and you recover faster. Then you’re in less pain,” Copelan said. The first few days after surgery are when surgical pain is at its peak, and after that, for most patients, pain recedes dramatically, he said.
The hospital has been using the drink, made by Ensure, in orthopedic surgeries for a while, and its use has been expanded to other surgeries.
“It is very well-tolerated,” Copelan said. “And the evidence is that patients recover really well.”
During surgery, heated blankets can be used to keep patients warm. “Research indicates that inadvertent hypothermia ranks among one of the most common complications during surgery,” Copelan said, and it has been recognized as a contributing factor to patient discomfort.
The hospital is also using injectable nerve blocks to target specific areas of pain. There are some newer nerve drugs that can block pain for 24 to 72 hours, Copelan said. Nerve blocks have been in use for years, but the newer ones are much longer-lasting.
With their pain reduced, patients are able to be mobile more quickly, which can speed recovery.
Another new advancement is IV-acetaminophen. “Surgeons have really been clamoring for this IV-acetaminophen because it works so well post-op,” Copelan said. Because it can go into an IV, the acetaminophen can be given to patients immediately after surgery, before they are able to take anything by mouth.
There are also medications that reduce nerve sensitivity that can be used in the hospital and at home.
“For many patients, these medications are as effective as opioids without the potential adverse effects that may occur with opioid medications,” Copelan said.
Copelan said they have been monitoring patients after surgery that are using the ERAS pain protocol.
“It seems to be working really well, the pain scores are good, the pain is being managed well,” Copelan said.
Patients still get opioids if they need them, but they often don’t need as many or need them as long.
The opioid crisis has made health care providers realize the need to reduce the dependence on opioids to manage pain, Copelan said. “And that really initiated a lot of this new research and new evidence.”
Piedmont is also looking into other options such as cryotherapy. “There are a lot of ways to manage pain that we don’t even use in the hospital right now,” he said.
Many patients are still in pain when they go home after surgery, and they go home with prescription opioids. Helping them get better faster can reduce the amount of opioids they need, and using other types of pain management in the hospital can reduce their overall exposure to opioids, according to Copelan.
Through the electronic medical record system, Piedmont is also looking to identify patients who might be at greater risk of becoming dependent on opioids, Copelan said.
“The system is also tracking prescribing patterns for doctors, practices and locations to be sure we don’t have any outliers,” Copelan said. “We want to be sure that everybody is following appropriate pain management protocols.”
If outliers are found, “we provide education,” Copelan continued. “If we see an outlier it may be for a perfectly good reason, maybe they’ve got more patients with chronic pain,” he said.
For those who already suffer from opioid addiction, Copelan said the goal of Piedmont Healthcare is to educate and remove the stigma for those suffering from addiction so that they can feel free to seek help.
“Patients can become addicted from just a few doses, and hundreds of Americans continue to die daily from opioid overdose related to both prescription and illegal opioids,” he said. “We will work cooperatively with our community to help direct these individuals to services that will provide the help they need.”