Dr. James Speicher, a thoracic surgeon at ECU Health Medical Center and director of the Thoracic Surgery residency program, and his team are working to improve pain management in patients after their surgery.
After meeting with other thoracic surgeons outside of the ECU Health system and hearing a presentation on non-opioid pain management, Dr. Speicher knew it was something he wanted to bring to his thoracic surgery patients in eastern North Carolina.
“I said, ‘That’s a great idea.’ I came back from the meeting and said to the team, ‘Hey, let’s try to do this.’ It took us some time to get access to one of the medications we would use in the pain management protocol, but we started with our protocol multimodal pain management while avoiding narcotics in 2019.”
Dr. Speicher said the new pain management protocol includes a long-acting local anesthetic for nerve blocks, along with a muscle relaxer, nerve pain medication, acetaminophen and anti-inflammatories.
The goal of the program was to send fewer patients home with prescription narcotics while limiting the use of patient-controlled analgesia pumps for patients in the hospital after surgery.
As the team looked at surgical data from 2016-19 and compared it to the study, running from 2019 to today, he said the team found even better results than they were expecting.
“What we found with our study was we had really significant reductions in the uses of opioids. It was around an 85 to 90 percent reduction in our opioid use inpatient and around 60 percent of patients weren’t going home with any sort of narcotic prescriptions,” Dr. Speicher said. “The other thing that was really impressive to me in the study was that our average pain score was actually better for our patients on the non-narcotic protocol. We were reducing the use of narcotics on the floor, sending people home with less prescriptions and introducing fewer opioids into the community, all while actually doing a better job controlling their pain.”
The opioid-free pain management program is part of a larger enhanced recovery after surgery protocol, which Dr. Speicher and his team has been working on over the last few years. He said the team has put in place walking protocols and pre-operative carbohydrate loading along with other changes that have been shown to improve outcomes for patients.
This program is active for thoracic surgeries at ECU Health Medical Center.
“This is exciting work for us because we’re really focusing on helping make patients comfortable, controlling their pain post-surgery and getting them home more quickly,” Dr. Speicher said. “If we can do all of that without a narcotic prescription, that’s a really big win for the patients we serve and the community as a whole.”