As healthcare providers, we must thoughtfully consider the role that we play in the nation’s opioid epidemic. Orthopedic surgeons are ranked the third highest physician prescribers of opioids in the United States1. Orthopedic hospitals are in a prime position to implement strategies that optimally address post-operative pain while positively impacting the nation’s opioid crisis. With the synergistic effect of multimodal pain management2 using a combination of opioid and non-opioid medication and less invasive surgical techniques, our organization was in an optimal position to reevaluate our current pain regimen and introduce evidence based opioid-sparing strategies. Such changes required deliberate steps to change organizational culture related to pain management and prescription practices.
Relevance/Significance (Why):
The misuse of opioids-including prescription pain relievers is a national crisis with a significant increase in mortality rates. Even with the use of opioids, numerous patients within our orthopedic hospital continue to report inadequate pain control and a vast amount of opioid related side effects. This has brought an awareness on the appropriateness of treating patients with narcotics after orthopedic surgery.
Strategy and Implementation (How):
A small pilot group of patients from our Total Joint Replacement Same Day Discharge (SDD) Program was used to assess actual postoperative opioid use. An opioid-sparing pathway was created for the SDD Program, in an effort to better address post-operative pain and minimize the number of unused opioids. Initially, patients were prescribed oxycodone approximately 60 tabs for use post discharge but in the new pathway, tramadol was prescribed with a maximum of 12 tablets. The pathway also included the multimodal pain management approach pre-, intra- and post-operatively; senior leadership support to transition towards an organizational culture related to multimodal pain management; interdisciplinary staff education, and the development of patient education materials inclusive of setting practical expectations regarding pain control for both patients and providers.
Evaluation/Outcomes (So what):
SDD post-implementation patients reported adequate pain control with fewer post-operative side effects. No statistically significant difference was observed in patients postoperative pain scores (p>0.05).This could indicate that the new opioid-sparing protocol demonstrates outcomes equivalent to the traditional protocol without exposing patients to the same degree of opioid related side effects.
Implications for Practice (And now):
Due to the overall success of the opioid-sparing initiative among the SDD cohort, a decision was made to create a similar pathway for our traditional total joint patients.
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