Taking Opioids Out of Anesthesia Decreases Post-Surgery Nausea

Taking Opioids Out of Anesthesia Decreases Post-Surgery Nausea

By Staff.

A study of over 1,000 patients shows that using opioid alternatives during general anesthesia is safe, effective and dramatically decreases postoperative nausea.

An effort by TEAMHealth Anesthesia at Select Physicians Surgery Center in Tampa, Florida set out to reduce the use of opioids during and after surgery.  The findings of their study suggest anesthesiologists are using pain management alternatives to opioids and are making headway in combating the potentially addictive medications.

“Opioids crept into general anesthesia over the years because they don’t cause problems with the cardiovascular system, but our research suggests we can use alternatives safely and effectively,” said David Samuels, M.D., lead author of the study and medical director of anesthesia at Select Physicians Surgery Center and medical director for TEAMHealth Anesthesia, Tampa. “By avoiding the use of opioids intraoperatively and helping surgeons understand the value and importance of offering patients different options for pain after surgery, physician anesthesiologists can be agents of change in addressing the opioid dependency crisis.”

Opioids, like fentanyl, are typically included in the combination of medications given to patients for general anesthesia during surgery.  In the study, 1,009 patients who were having head and neck surgery received general anesthesia without opioids.  Instead, patients received various combinations of magnesium, sub-anesthetic ketamine, lidocaine and ketorolac, depending on the patient’s age and health. Surgeons and patients expressed a high degree of satisfaction with the new anesthesia protocol and postoperative pain management.

After surgery, 11 percent of patients experienced nausea, whereas 50 to 80 percent of patients typically suffer from nausea after surgery.  Additionally, 64 percent of patients did not require any pain medication postoperatively.

The traditional use of fentanyl in general anesthesia can cause hyperalgesia, or increased sensitivity to pain, Dr. Samuels said.

“Hyperalgesia leads to increased pain, so patients request more opioids in the recovery area, and then go home with an excessive number of pills,” said Enrico M. Camporesi, M.D., co-author of the study. “We believe that not using fentanyl during surgical anesthesia, as well as not providing patients too many pills after surgery, may help decrease the likelihood of opioid abuse. Studies show that 1 in 15 patients who has surgery is still taking prescription opioids 90 days afterwards,” he said.

Three of the 19 surgeons who participated in the study now prescribe patients daily oral magnesium, gabapentin and ibuprofen for pain management after surgery. They also prescribe five hydrocodone pills for any breakthrough pain. Previously, these surgeons prescribed 50 hydrocodone pills. The change to five pills will lead to 27,000 fewer prescribed hydrocodone pills in one year’s time for these surgeons at their practice.

The researchers say they plan to study whether avoiding opioids during surgery and reducing opioid prescriptions after surgery leads to reduced opioid use and abuse.

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Authored by: Staff

There are 11 comments for this article
  1. sandy Auriene Sullivan at 9:18 am

    We do need to sue, but not our doctors. We need to go after the Federal Government for discrimination against Americans With Disabilities. We are a target, we are dying due to *their* negligence which is grounds for civil action. We do not want money, we want to bring back sane policy and to stop hurting those of us who have proven disabilities; as well as proving disability in others.
    If you’re new to chronic pain as my friend said, you can’t even get in the LINE for help right now.
    Doctors are being bullied into taking on the CDC guidelines as LAW but they are not law. Doctors are terrified.
    This study as with many studies is a joke. Just wait until some rich guy gets denied treatment. A doctor, lawyer or politician. It takes *real* wealth to avoid the guidelines. Like 100 million dollars in assets to avoid this [edit]. As those doctors have the funds too to take on the government.
    It is time.
    For example, I met 90mme in September on my own. Cutting on my own. Now he wants to put me on Suboxone because he was bullied in October by local/state/feds. Now riddle me this… how is 160mme with naloxone *safer* than 90 or less mme? Hint: it isn’t. naloxone doesn’t know if you are abusing or not, it only prevents euphoria from the buprenorphine. WHICH CPPS do not get from their pain meds!
    My family, [mom, dad, s/o, friends ] all are against me being put on suboxone. They’ve never seen me abuse. It will put me at respiratory depression risk going from a 90mme to 160mme overnight – euphoria or not!
    We are doing this all wrong and there’s case law to stop it already out there 20+ years old. There’s also protection against this sort of discriminatory practice to hurt ONLY chronic pain patients and force-tappers and/or forced/coerced suboxone only options labeling people like me as an addict as it IS off label use for chronic pain…. that puts me at an enormous risk if I need any other assistance from the ER or any other doctor who doesn’t grasp ‘off label’ [afraid colleagues] high risk scripts.

    It reeks of racketeering.

  2. J P in pain at 6:40 pm

    The only REAL “opioid CRISIS” is the one that the gov & the media has “made” !!! I’m not sure who (in GOV) is behind all of this crap but about the only people DYING these days “because of opioids” are those “LEGITIMATE PAIN PATIENTS” who are in SUCH AGONY THAT THEY CANNOT BEAR THE P.A.I.N. ANY LONGER !!!! The drs who refuse to DO THEIR SWORN DUTY & “**HELP**” their patients – like those in chronic pain to get OUT OF SAID PAIN – then those drs NEED TO BE *SUED for INHUMANE TREATMENT OF THEIR PATIENTS!! *WHERE are all the LAWYERS who seem to be just hunkering down while all of us in pain are treated like ANIMALS !!??? Heck ANIMALS in pain are treated MUCH better than WE ARE!! WAKE UP PEOPLE!! Our HUMAN *RIGHTS to NEEDED MEDICAL TREATMENT have been violated & RIPPED AWAY!! & MOST people just LAY DOWN & TAKE IT !!?? WHY !?!? Stand up & FIGHT for what’s RIGHT…or at least those of us who still have the strength *TO stand up!! >:0(
    & BTW, just **WHO is BEHIND THIS INSANE ASSAULT ON PEOPLE IN PAIN ???? We need to find out *WHO! & *WHY! & PUT A *STOP TO IT…one way or another !!!
    Signed: “FED UP WITH THIS *FAKE ‘opioid crisis’ CRAP” !

  3. Eileen at 6:05 pm

    Not every1 is a candidate 4 toradol as I have factor 5 a clotting disorder which requires me to be maintained on Coumadin. Last hospitalization in August 4 pulmonary embolism, I was maintained in toradol 4 5 days prior 2 a house Dr coming in & telling me he D/cd tge toradol as it cld cause a brain bleed, so switched it to dilaudid. I bet I would not get anythg as the situation is today. So again it’s not a one size fits all drug! Also any1 wth decreased kidney functions are not candidates. So opiates it is, good luck with that, they wld rather you suffer!

  4. Eileen at 5:53 pm

    Good Lord they clearly said it had to do with the “opoid crisis” that thy decided nt to use opiates bc of potential addiction. I will NEVER have any elective surgery if appropriate analgesia is not offered! Your rght Dr Ibsen, untreated acute pain definately leads to chronic pain. As a retired RN we hav always made sure the patient was comfortable prior to leaving the recovery room, now there concerned about addiction beginning in the operating room. God help us all!

  5. Beckys at 11:31 am

    No specifications on whether it was bone or flesh surgery. No specifications on pain reactions to other painful stimuli prior to surgery.
    I have never had this exorbitant amount of pain meds prescribed for mastectomy nor hysterectomy as the 50 number.
    Go after the abusers for sure but don’t lump all people in the same category just in case there are some whose normal pain stimuli is on a lower or higher level.
    Good study. Btw, magnesium can cure other ills, so it will put a crimp in Big Pharma’s profits.

  6. Michael G Langley, MD at 6:37 am

    That was actually twenty years ago that I was using the Toradol. Time flied when you are having fun…hurting!

  7. Michael G Langley, MD at 6:36 am

    I found that IV Toradol was a wonderful substitute, fifteen years ago! Its use has to be limited because it had a bad propensity to cause bleeding if used for over ten days. In my case (post operative for hernia surgery) when Dilaudid was not working, it killed the pain completely, leaving me to overdose because the elevated dose of Dilaudid was not countered by pain. The patients started eating earlier. I even sent a patient, who had a gallbladder removal, home the following day I must point out it was not a laparoscopic procedure! The fact that narcotics caused these problems is nothing new, to the doctors who kept up and reasoned out the proper medications that showed distinct advantages. That being said, it has nothing to do with the “opiod crisis” that the media is now plastering all over the airwaves. Even the entertainment industry, HBO, got their thoughts it the mix. The biased and one sided special that in watched disgusted me. They showed everybody as high and disoriented..basically the abusers who used the medication for the wrong reason. It did not even represent one thing about the chronic pain patients being forced to suicide because of under-treated chronic pain! Why is it that we have so many uneducated “experts”?

  8. Pain patient at 6:20 am

    There’s NO way that this would be enough Pain management for orthopedic surgeries like hip replacements. I’d like to see these doctors try it.
    I wish the media and some of the medical community would stop demonizing CP patients because of the actions of some who abuse Pain meds.
    Most of us would gladly stop using opiates if anything else worked as well. Yes we can add other meds but the opiates are the only thing that works for major pain and nerve pain.
    After 11 years of being in pain I can say that I wouldn’t have lasted this long without pain meds. The nerve pain would have driven me over the edge.
    Leave us alone and address why so many young people are using heroin and other hard drugs.

  9. HJ at 5:25 am

    Awww, heck. Let’s not even put people under any more.

  10. Juli Snyder at 4:46 am

    So in other words.. Out of All the People that Live in The United States, this report is saying that there’s no need for More than 5 pain pills after having surgery.. So in Tampa FL, 1009 people were in this study.. So they have the opinion of everyone else in The United States, to say We don’t need to have these meds after surgery. This Upsets Me!! I’ve had Countless Surgeries and I can say from 4 Major left knee SURGERIES with a replacement, Lumbar Fusion, a horrible Hysterectomy that no amount of mild pain meds could take away the pain, because they saw fit to only give me Tordol.. Was in ICU for 5 days because of said Hysterectomy, but now 1009 folks can say there’s no reason it need for Pain Meds.. So in other words, if you’re the Doctor, your not the one laying in the recovery room in pain, but you have the Right to tell Me that if I was to go home with Pain Meds, I can become Addicted, therefore You’d rather have Me in Pain!! I’m not and WILL NEVER FIND THE WANT OR THE NEED TO GO TO STREET DRUGS!! I.. HERION!! A Doctor’s OTHE . FIRST DO NI HARM!! SO THEN WERE DOES THAT COME INTO PLAY!! DO NO HARM!!

  11. Mark Ibsen MD at 3:17 am

    It’s always a good sign
    When they say :
    “Studies show”
    I hope they publish the results.

    Especially when the maltreatment of acute pain
    Is
    Found AGAIN to lead to chronic pain.
    Here we go,
    Back to the culture.
    Doc, Marty, Biff and the DeLorean,
    On a railroad track to Agony.

    Screams, torture and so much blood: The gruesome world of 19th-century surgery – The Washington Post
    https://apple.news/A4G10-dFWTEqbBxk2rnJ-vQ

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