Postoperative pain management

for plastic surgery

6.5% of patients undergoing surgery will develop opioid dependence.1 But even for the 93.5% who do not become dependent, overprescription still comes with dramatic societal costs.

The dangers of diversion

The extent of the opioid crisis has made it clear that anyone has the potential to become dependent on opioids. Even when your patients recover from their surgeries without incident, the prescriptions they bring home could put their loved ones at risk.

Patients want a quick and comfortable recovery, but opioids can have a dramatic ripple effect if pills are diverted to nonmedical use. Opioid discharge prescriptions filled by recovering surgical patients result in more than 1 billion unused pills, and 90% of these remain inside the home.1-3

Given that 32% of all opioid addicts report first exposure through leftover pills, diversion is a serious contributor to the opioid crisis.4 Finding ways to confidently relieve postoperative pain while relying less on narcotics could help to curb the epidemic.

Local anesthetics have the potential to act as a strong foundation for postoperative pain management, but generic local anesthetics are not designed to provide pain relief beyond 8 to 12 hours, and even 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. Therefore, opioids are often used to fill the gap.2,5-8

Learn more about why opioids are not the optimal solution for postoperative pain management »

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References: 1. Brummett CM, Waljee JF, Goesling J, et al. New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg. 2017;152(6):e170504. doi:10.1001/jamasurg.2017.0504. 2. Hill MV, McMahon ML, Stucke RS, Barth RJ Jr. Wide variation and excessive dosage of opioid prescriptions for common general surgical procedures. Ann Surg. 2017;265(4):709-714. doi:10.1097/SLA.0000000000001993. 3. Bates C, Laciak R, Southwick A, Bishoff J. Overprescription of postoperative narcotics: a look at postoperative pain medication delivery, consumption and disposal in urological practice. J Urol. 2011;185(2):551-555. doi:10.1016/j.juro.2010.09.088. 4. Canfield MC, Keller CE, Frydrych LM, Ashrafioun L, Purdy CH, Blondell RD. Prescription opioid use among patients seeking treatment for opioid dependence. J Addict Med. 2010;4(2):108-113. doi:10.1097/ADM.0b013e3181b5a713. 5. Berde CB, Strichartz GR. Local anesthetics. In: Miller RD, Cohen NH, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL, eds. Miller’s Anesthesia. Vol 2. 8th ed. Philadelphia, PA: Saunders; 2015:1012-1054.e4. 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. 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.