While opioids can be effective analgesics for postoperative pain, they are often associated with adverse events that can make recovery more difficult for patients.1
Opioid-related adverse events (ORAEs) can range from nausea and vomiting to central nervous system impairment and respiratory depression. Because treating ORAEs can require additional medications and personnel, these complications can contribute to higher costs and a longer hospital length of stay.2
According to one study, patients who experienced an ORAE after undergoing a common surgical procedure stayed in the hospital an average of 3.3 days longer and resulted in an excess hospital cost of $4,707.2
How nurses can help prevent overprescription of opioids
With severe pain often lasting beyond 24 hours, we rely on opioids to pick up where local anesthetics leave off.
But what if local anesthetics could last longer?
The role of nurses has undeniably grown in our modern health care system, and it is crucial that nurses are empowered to advocate for their patients when it comes to avoiding opioid use when there are effective alternatives. An analysis of 2,455 sentinel events (75% of which resulted in patient death) reported to the Joint Commission for Hospital Accreditation found that the primary root cause in over 70% was communication failure. Effective teams, the report finds, allow all participants to feel they have the responsibility to speak up when they have concerns.3
One important tactic in minimizing the use of opioids for postoperative pain management is the use of local anesthetics. Local anesthetics have the potential to create a strong foundation for pain management after surgery. However, generic local anesthetics are not designed to provide pain relief beyond 8 to 12 hours, and longer-acting local anesthetics exhibit limited and inconsistent efficacy beyond 24 hours in part because the inflammatory process inhibits their ability to penetrate the nerve cell membrane. With severe pain often lasting beyond 24 hours, we rely on opioids to pick up where local anesthetics leave off.4-8
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References: 1. Kessler ER, Shah M, Gruschkus SK, Raju A. Cost and quality implications of opioid‐based postsurgical pain control using administrative claims data from a large health system: opioid‐related adverse events and their impact on clinical and economic outcomes. Pharmacotherapy. 2013;33(4):383-391. doi:10.1002/phar.1223. 2. Oderda GM, Gan TJ, Johnson BH, Robinson SB. Effect of opioid-related adverse events on outcomes in selected surgical patients. J Pain Palliat Care Pharmacother. 2013;27(1):62-70. doi:10.3109/15360288.2012.751956. 3. Leonard M. The human factor: the critical importance of effective teamwork and communication in providing safe care. Quality and Safety in Health Care. 2004;13(suppl_1):i85-i90. doi:10.1136/qhc.13.suppl_1.i85. 4. Berde CB, Strichartz GR. Local anesthetics. In: Miller RD, et al, eds. Miller’s Anesthesia. Vol 2. 8th ed. Philadelphia, PA: Saunders; 2015:1012-1054.e4. 5. Becker DE, Reed KL. Essentials of local anesthetic pharmacology. Anesth Progress. 2006;53(3):98-109. doi:10.2344/0003-3006(2006)53[98:EOLAP]2.0.CO;2. 6. Carvalho B, Clark DJ, Yeomans DC, Angst MS. Continuous subcutaneous instillation of bupivacaine compared to saline reduces interleukin 10 and increases substance P in surgical wounds after cesarean delivery. Anesth Analg. 2010;111(6):1452-1459. doi:10.1213/ANE.0b013e3181f579de. 7. Kim J, Burke SM, Kryzanski JT, et al. The role of liposomal bupivacaine in reduction of postoperative pain after transforaminal lumbar interbody fusion: a clinical study. World Neurosurg. 2016;91:460-467. doi:10.1016/j.wneu.2016.04.058. 8. Svensson I, Sjöström B, Haljamäe H. Assessment of pain experiences after elective surgery. J Pain Symptom Manage. 2000;20(3):193-201. doi:10.1016/S0885-3924(00)00174-3.