Mile Bluff’s nurse anesthetists are experts in providing pain management
to patients both before and after surgery. The team continually assesses
pain management practices to ensure that what is provided to Mile Bluff
patients is what is proving to be effective elsewhere. One of the emerging
trends that is becoming a standard of care at Mile Bluff, is the cutting-edge
option of opioid-free anesthesia.
About opioid-free anesthesia
Opioid-free anesthesia (OFA) allows the use of anesthesia without the
use of opioid medications. This technique provides patients with safe
anesthesia for surgery, while maximizing their respiratory function and
eliminating the unwanted side effects of common opioid medications.
Traditionally, anesthesia during surgery relied heavily on monotherapy
(the use of one medication)to do all the ‘heavy lifting’ in
treating surgical-related pain. Opioids were, and still are, a mainstay
in pain management during surgery. Opioids block pain by reducing how
it feels. They do not treat the cause of the pain, only the effect. However,
surgical pain is quite complex in how it is generated and how it impacts
After surgery, a patient’s nervous system senses and magnifies pain
signals in the body. Rather than reducing the impact of pain from surgery,
OFA works to treat pain at its origin. Using a variety of non-opioid medications
and nerve blocks to target specific areas that pain is caused from, pain
is treated aggressively in different ways without the use of opioids.
Instead, anti-inflammatory medications, medication that protects the nervous
system, muscle relaxants and other medications are used.
“Using OFA allows us to effectively treat patients’ surgical
pain, and often, more successfully than with traditional anesthesia,”
explained Micah Playman, one of Mile Bluff’s nurse anesthetists.
“Since OFA is targeted treatment to the source of pain, patients
have increased comfort, improved healing and better function after surgery.
Patients tend to feel better, have much less opioid-related side effects,
and a lower risk of addiction.”
Almost all surgeries and patients would benefit from opioid-free anesthesia.
There may be rare cases in which allergies to certain select medications
may limit the ability for total opioid-free anesthesia. However, those
examples are rare and should not stop a patient from using at least some
level of OFA. At the very least, patients with allergies can have a significant
reduction in the total dose of opioids if using OFA.
Reducing opioid dependence
“There is no question an opioid epidemic exists across the country,
and right here at home,” said Micah. “Many patients and their
families have been negatively impacted by the misuse of opioids. There
is a place and time for the use of opioids, but they are powerful medications
and should only be used for the most severe forms of pain.”
As healthcare providers across the country are looking for ways to reduce
the prescribing of opioids, Mile Bluff’s nurse anesthetists are
examining how they provide pain management to patients. “At one
time there was a thought that there was little way around giving opioids
for pain management,” explained Micah. “Research has since
proven otherwise, and as a profession we are able to use opioids less
Micah continued, “It is very clear now that opioids are not required
to be used at all. Research is showing that routine use of opioids for
stopping acute pain likely does more harm than good. There is even evidence
to suggest that using opioids may produce an inappropriate pain response
during surgical stress and recovery.”
Having options for surgical care and acute pain treatment is beneficial
to patients. Gone are the days of ‘one-size-fits-all’ medicine.
Mile Bluff’s nurse anesthetists appreciate being able to use their
expertise to customize anesthetics/medications to each patient.
Opioid-free anesthesia allows for:
- minimizing the risk of respiratory issues during surgery for those at high
risk (those with COPD, sleep apnea, obesity, etc.)
- improving outcomes for those with chronic pain conditions
- providing options to safely manage surgical pain for those on chronic opioid
therapy, and those recovering from addiction
- reducing the risk of cognitive issues following surgery
- improving immune system function after surgery
Managing pain expectations
All patients experience pain differently. Regardless of the type of medication
used, patients need to have a realistic expectation that having surgery
involves some pain and discomfort.
“We want our patients to have safe anesthetic above all else,”
said Micah. “When OFA is used, patients should not expect to be
entirely pain-free immediately following surgery. Instead, they will experience
tolerable amounts of pain. Having tolerable/functional pain after surgery
is normal. It allows your body to communicate with you about the healing
process. That being said, patients can rest assured that their pain after
surgery will not be left uncontrolled.”
Before undergoing surgery, patients are encouraged to have a pain management
plan in place following surgery. Having a plan in place helps improve
patient function, patient satisfaction and healing. It also lessens and
reduces complications. Making a plan with primary care providers, surgeons
and/or nurse anesthetists, helps to set recovery goals, as well as realistic
expectations on the amount of pain that will be felt following surgery.
Opioid-free anesthesia is still a new concept for many healthcare organizations.
“At Mile Bluff, we are dedicated to keeping up-to-date with many
advanced anesthesia concepts and techniques, including OFA,” said
Micah. “Using OFA is not yet widely used among hospitals. As the
successful strategies of OFA become more known, it is very likely other
hospitals will incorporate this technique into their practice.”
The Anesthesia Services team at Mile Bluff encourages patients to ask questions
and share concerns with their surgeon and anesthesia provider before surgery.
Doing so allows for everyone to have a clear understanding of pain management
goals and expectations, in order to reach the best surgical outcome.
For more information about opioid-free anesthesia and other pain management
options available at Mile Bluff, call the Anesthesia Services Department