Congress Daily - Saturday, August 10, 2019


'How Low Can You Go?' - The Future of Opioid-Sparing Trends and Techniques

  • Aug 10, 2019

Kristin Henderson, DNAP, CRNA; and Richard Flowers, Jr., DNP, CRNA; will be presenting a session on opioid-sparing trends and techniques on Sunday, August 11, from 1:30 - 2:30 p.m. in the Grand Ballroom A-B, Ballroom Level, East Tower, Hyatt Regency Chicago hotel. AANA Congress Daily staff asked Flowers and Henderson to talk about the opioid crisis and how opioid-sparing techniques are coming to the rescue.

Congress Daily: The opioid crisis took years to build to its current level. Will opioid-sparing protocols do enough to make a worthwhile impact on the crisis quickly enough? Is it too late to implement opioid-sparing protocols?

Henderson: It’s never too late to apply opioid-sparing (OS) protocols! One of the most exciting aspects of OS is how applicable it is to every surgery type and patient sub-set. I feel that the more CRNAs use this approach, the more patients and providers will benefit. In the coming years, we will continue to learn about how helpful and effective this new path in anesthesia can be!

Flowers: Anything we can do to limit exposure to opioids will have an impact. It’s never too late, but if you haven’t started to implement multimodal analgesia into your anesthetic plans, you are already behind!

Congress Daily: We know that overprescribing has helped to fuel the opioid crisis. Would you say that America’s desire for a cure-all solution to any medical ailment (“There’s a pill for that”) is partly to blame for the opioid crisis? Is a philosophical change necessary to right the crisis?

Flowers: I think the causes are multifactorial to say the least, but yes, partly to blame for sure. We need a philosophical change in regards to how we define and measure pain and our expectations regarding the normality of pain after surgical procedures.

Henderson: I agree with Richie that there are many factors at play. I feel that as a healthcare culture, if we continue to embrace Enhanced Recovery After Surgery (ERAS®) and counsel our patients in the ERAS approach, huge benefits will arise. The foundational principle behind ERAS is that the patient is a key player in their own recovery. By empowering them with knowledge, and alternative resources based on the latest evidence, I know we can continue to improve patient outcomes.

Congress Daily: Have you found that patients are willing partners in the opioid-sparing approach to recovery after surgery?

Henderson: YES! Each time I have the opportunity to explain the benefits of opioid-sparing (OS) approaches, the patient has been curious and interested in this approach. I have learned that our patients are often as interested in the latest research and improved outcomes as healthcare providers are! I always assure them that opioids are a back-up option once we assess their comfort levels in recovery, and that seems to get their full investment in OS.

Flowers: Absolutely. I think the prevalence of news stories and personal experiences related to the opioid crisis has created a level of awareness that is resulting in patients, on the day of surgery, having concerns about what kind of medications they will receive for pain during and after surgery. It really provides an open door to discuss opioid free and sparing alternatives to opioids. In my experience, most people seem relieved to discover that we are confronting the issue and are more than willing to cooperate.

Congress Daily: How can CRNAs and SRNAs come up to speed on opioid-sparing alternatives to help combat the opioid crisis?

Flowers: This is difficult. We have incorporated this into the didactic education of our students, but we hear feedback from them that many of the CRNAs they work with clinically are not on the same page.  Understandably this is a big change for CRNAs who have spent their entire careers utilizing narcotics as a primary component of their anesthetics. So I think we have a lot of work to do in educating practicing CRNAs in the methods and values of multimodal analgesia.

Henderson: I agree with Richie on this as well. The students are eager and willing to try OS and multimodal plans. I think it is most helpful to get the information on outcomes, and approaches to opioid-sparing into the hands of the practicing CRNA. That is why I am so passionate about speaking on the topic! I was trained to use high doses of narcotics, and did so for many years before my practice changed. I feel that if I could change, then anyone can give these techniques a try and see very satisfactory results!

Congress Daily: What else would you like our members to know about where we are headed as far as opioid-sparing alternatives and their place in surgery and recovery?

Flowers: The opioid crisis has been an impetus for change and adoption of opioid-sparing techniques, but the benefits of reducing opioids that have been uncovered are the real reason that we will see a continued push in this direction. I really believe that opioids will rarely be a part of most anesthetics in just a few short years.

Henderson: I agree. As institutions adopt ERAS protocols, and surgeons continue to collaborate with anesthesia providers, I see a big shift in how we view surgery and outcomes related to narcotic use. The surgeon often is left to manage many of the poor outcomes related to intraoperative and postoperative narcotic administration in the time after patients leave our anesthesia care. Using opioid-sparing isn’t a critique of any CRNA’s ability to deliver care. It’s a method to improve the patient’s surgical experience, reduce postoperative nausea and vomiting (PONV), speed time to discharge, and eliminate many post-op complications requiring readmission.

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