‘I didn’t want to rely on opioids as a crutch for anything’: Doctors works to minimize narcotic use after surgery
HORRY COUNTY, S.C. (WMBF) - Orthopedic surgeons said hip and knee replacement surgeries are some of the most common adult reconstructive procedures, with roughly 600,000 individuals undergoing knee replacement and more than 300,000 total hip replacements annually.
“Knee replacements and hip replacements are probably two of the most widely-done orthopedic procedures. We at OrthoSC do thousands of knee and hip replacements a year. It’s an incredibly successful procedure,” said Dr. Tyler Noble, orthopedic surgeon with OrthoSC.
Opioids are the common turn-to after the procedure to help with pain management. In fact, research shows orthopedic surgeons are the third-highest prescribers of these medications, writing more than six million prescriptions a year. As a response, medical professionals and institutions are rethinking post-surgical pain management strategies in light of the nationwide opioid crisis.
Carmelo Bonnano, 74, is one of hundreds of Noble’s patients. In November, he endured his second knee replacement surgery of the year.
Noble, however, points out over the past decade, a lot has changed when it comes to the post-operative process.
“Ten years ago, it was not uncommon for patients to stay in the hospital for two weeks after a knee replacement. Then we’re just doing the oral medications, like the oxycodone and the hydrocodone, but then as we found out we can do other things, we can do different injectables of medications and then we can 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.”
Noble said there’s been a trend where patients expect narcotics following joint replacement surgery but now, doctors and patients are realizing prescription pain medications aren’t always needed. There’s been a shift in the approach to pain management that minimizes narcotics exposure while working to improve outcomes.
As a response, Conway Medical Center has been working to reduce the need for narcotics after surgeries through its joint replacement program and multi-modal pain management treatment approach, with even more of a push this year.
Conway Medical Center partnered with one of the longest-established orthopedic practices in the Grand Strand area, Coastal Orthopedics. Over the past year, 93 percent of patients are going directly home after a joint replacement surgery. Noble believes patient education is key.
Doctors said by well-informing patients ahead of surgery on what to expect as far as pain and recovery, it can make all the difference.
"So reassuring patients, telling them what to expect - so this is a knee replacement, this is a major surgery, it’s going to be uncomfortable - we will do what we can to make your pain comfortable,” Noble said. "No patient is going to want to have surgery if they feel we’re not going to be able to control the pain.”
He added having a plan to control pain after the surgery can help avoid unnecessary use of opioids. Noble stresses the key to effective pain management is a combination of methods. It can consist of Tylenol, physical therapy and something as simple as ice.
In efforts to minimize narcotics use, Conway Medical Center sends patients home on the lightest narcotics possible and mixed with other medications like anti-inflammatories, non-narcotic medications, etc.
Bonnano is one of the many patients who wanted to avoid taking narcotics for post-op treatment.
“Drugs to me is a crutch. You have to deal with things and it’s going to be painful. I’m not going to say it’s not going to be painful, but the more you work, the more you treat yourself, the less the pain gets, and that’s what I didn’t want. I didn’t want to rely on opioids as a crutch for anything,” said Bonnano.
Instead, he used Tramadol for a very limited time after surgery, then quickly switched to Tylenol. Bonnano is now finishing up his last week of physical therapy.
Staff at Conway Medical Center said Bonnano’s recovery process is ahead of where the average patient is at. The goal after a knee replacement is to have a range of motion of 120 degrees or higher, and Bonnano was at 115 at two-and-a-half weeks, which is right on track for a healthy new knee.
A report by Athena Health Network in 2017 found orthopedic surgeons nationwide have significantly dropped their opioid prescribing. Numbers show a 13.4 percent decrease from early 2014 to early 2017.
Conway Medical Center leaders said they hope to follow this trend.
“The message we’re trying to send people is 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, great. If you’re not adequately controlled and you’re not doing what you need to do in therapy because of your pain, but then yeah there’s no problem at all giving you those medications,” said Noble.
For more information on orthopedic care available at Conway Medical Center, click here.
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