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Opioid-Free Emergency Department – Lessons from Outpatient Surgery

May 13, 2020

Written by Clay Smith

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Use of dexmedetomidine, NSAIDs, and nerve blocks drastically reduced opioid use at this pediatric surgery center.

Why does this matter?
Over 5% of patients may have persistent opioid use after surgery. That is >2 million people out of the 50 million per year in the U.S. who have surgery. What if we could reduce opioid use in the perioperative period and still provide excellent pain control?

Fighting opioid misuse at the root
This was a quality improvement initiative at a single pediatric surgery center to reduce opioid use. Over the course of 18 months, this QI initiative was highly effective, reducing intraoperative opioids from 84% to 8% and postoperative morphine use from 11% to 6%. Pain control scores remained unchanged. Post-operative nausea decreased as did analgesic-related costs. How did they do it, and how that might apply to the ED? Instead of using opioids, they focused on dexmedetomidine, IV NSAIDs, and the use of nerve blocks. These are three things we could do in the ED right away. The dose of dexmedetomidine was 0.5 to 1.0 μg/kg for most procedures. This is also an encouragement for me to improve in the use of nerve blocks. If a surgery center can pursue being opioid-free, certainly we can do it in the ED. Keep in mind, this was a single center, with only pediatric patients undergoing minor procedures, such as PE tubes, tonsillectomy, or hernia repair, which may not be generalizable to some situations in which severe pain must be treated.

In Pursuit of an Opioid-Free Pediatric Ambulatory Surgery Center: A Quality Improvement Initiative. Anesth Analg. 2020 Apr 10. doi: 10.1213/ANE.0000000000004774. [Epub ahead of print]

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