If surgery is in your future, it’s worth your while to ask for alternatives to opioids (narcotics).
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
“Narcotic dependence is now the most common complication of non-emergency surgery,” says anesthesiologist Eric Chiang, MD.
A University of Michigan study found that, of 36,000 patients prescribed opioids for the first time after surgery, up to 6.5 percent — about 2,000 to 2,300 people — were still filling prescriptions after three months.
“This study was eye-opening,” says Dr. Chiang. “It showed us that mere exposure to narcotics was enough to cause dependence.”
Opiate use after surgery
Patients are most often exposed to opiates after surgery, where evidence-based prescribing guidelines are desperately needed.
A look at prescribing habits by the Michigan group found that some surgeons prescribed 15 painkiller pills after laparoscopic gallbladder surgery, while others prescribed 120.
“Yet they found patients used only six pills or less, on average,” says Dr. Chiang.
Obstetrics is another area where narcotics are overprescribed. For example, nurses encourage breastfeeding, so when pain from a C-section interferes with it, they commonly give new moms painkillers.
“Also, it is all too common for U.S. obstetricians to prescribe narcotics to new mothers after uncomplicated vaginal deliveries,” says Dr. Chiang. “Currently, Pennsylvania is the only state to have published guidelines discouraging this practice.”
Opiates are prescribed in the weeks before surgery too. Surgeons may prescribe painkillers to patients in great discomfort from a hernia, for example.
“But some data show the chances of addiction are higher when patients are given prescription narcotics immediately before surgery,” he says.
Opioid use during surgery
Anesthesiologists are finding safer, equally effective ways to control pain in the operating room. “We combine non-narcotic pain medicines from multiple classes,” says Dr. Chiang.
For example, drugs they may combine include:
- Tylenol® or Motrin®
- Ketamine, a powerful non-narcotic analgesic
- Esmolol, a drug that controls heart rate and blood pressure. “Its use has been found to decrease the need for pain medication or even anesthetics during surgery,” he notes.
- Regional anesthesia using local anesthetics (epidurals, spinals or nerve blocks) to numb areas of the body.
“With today’s advances in anesthesia, more and more surgeries can be done with a nerve block and minimal sedation,” explains Dr. Chiang. “Or a nerve block can be combined with general anesthesia to decrease your overall exposure to anesthetics or narcotic medicines.”
Anesthesiologists can use ultrasound guidance to numb just the left breast, not the right; or just the front, not the back, of your knee.
“We don’t know if decreasing narcotics in the operating room will help with long-term addiction to opiates,” says Dr. Chiang.
“But new research suggests that giving patients narcotics while they are asleep may increase their need for them when they’re awake.”
An American problem
In Europe, surgeons and anesthesiologists work together to avoid opiates. In Germany, for example, providers uniformly give only Motrin to hysterectomy patients.
“That wouldn’t happen in the United States,” says Dr. Chiang.
Perhaps that’s why no other country in the world has our opioid crisis, which claimed over 65,000 U.S. lives in 2017.
“We need to reset our patients’ expectations,” he notes. “It’s not realistic to expect zero pain from surgery. Our goal is to help patients manage an acceptable amount of pain.”
Scheduling surgery soon?
If you’re scheduled to have surgery, talk to your surgeon and anesthesia team about using non-narcotic medications, regional anesthesia and nerve blocks.
This is especially important if you’ve ever had a smoking habit, or depression, or been addicted to alcohol or drugs.
“Other addictions increase your risk of opioid dependence,” explains Dr. Chiang. “Because certain people are more susceptible, genetic research is underway.”