Opioid-free surgery arrives at Albany Med

May 15, 2018 06:54 PM

There are many ways to tackle the opioid epidemic. One of them is in the operating room.

Reducing the use of the opioids during surgery started back in the 1990s in Denmark. It's taken a while to catch on and cross the Atlantic, but now that it has, it's changing how doctors at Albany Medical Center practice.

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Albany Medical Center is now a leader in the Northeast when it comes to narcotic-free surgery. Anesthesiologists and colorectal surgeons partnered on this approach over a year ago. The goal was to get patients home faster. Reducing reliance on opioids was a by-product. Now, with more than 400 surgeries completed, they're ready to call it a success.

"I would just completely lose the whole day," explained Mary Pat LaRose.

That's what recovery was like for her the seven other times she underwent surgery to control her Crohn's disease. However, this eighth surgery will be different. The narcotics that left her loopy before won't be prescribed this time for pain management.

"I was a little hesitant at first, because that's what I've always used in the past with major surgery," she admitted.

That was then and this is now and the colorectal surgery team at Albany Medical Center -- along with anesthesiologists, are limiting drugs like oxycodone and other opioids and with good reason.    

"Opioids is just one of the strategies for pain management and it's not the best one," noted Dr. Igor Galay, an anesthesiologist at Albany Medical Center.

Extensive research in pain management caught the attention of Dr. Galay and colorectal surgeon Dr. Brian Valerian. That was back in 2016 and they had a talk.

"I think it was over a cup of coffee," recalled Valerian.

That led to developing a team approach so everyone dealing with their surgical patients were on page. They even created what they call the "surgery bible" to better acquaint patients with what to expect both pre, during and post-surgery. That includes the fact they'll go home much faster without opioids, because opioids slow intestinal activity -- and you can't be discharged until that activity resumes. So now, without opioids, discharge happens within one to three days. Before, it was four to six days.

Even the doctors were skeptical early on by the fast recovery.

"We said, they're ready to go home, they're meeting all the criteria that we set forward to go home, we better keep them 'til tomorrow," noted Valerian.

Along with Tylenol and ibuprofen, patients may get a small supply of narcotics, but it's what happens in the operating room that changes the game.

"We rely heavily on nerve blocks and the technique most people are familiar with is injection of numbing medicine in the dental office," pointed out Galay.

Infusions of local anesthetic may also be used.

At the heart of this is changing expectations says Dr. Galay. Patients better understand that pain is associated with surgery. Their expectations are more realistic and rather than focus on a patient's pain, they zero in on overall patient well-being.

"I want it to work," asserted LaRose.

They've already expanded the non-narcotic surgery to urology and are looking to all other surgical procedures. For people who are on long-term opioid treatment, the goal is not to increase it for the surgery.


Benita Zahn

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