An anti-inflammatory bundle may help avoid opioids for low-risk outpatient procedures

Abstract

Background Currently, over half of drug overdose deaths are due to opioids. Opioid alternatives may be prescribed to help curb the opioid epidemic. However, little is known about their efficacy for acute postoperative pain. Methods We studied patients who underwent low-risk outpatient surgery. Perioperatively, all patients were started on an anti-inflammatory bundle consisting of multimodal pain remedies. Opioids were available to the patients postoperatively. Pain scores and opioid use were recorded. Results Over 18 months, 120 patients underwent low-risk outpatient surgery and all used the anti-inflammatory bundle. All patients had a significant decrease in postoperative pain scores (p = 0.001). There was no significant difference in postoperative pain scores between those who followed the anti-inflammatory bundle alone and those who also used opioids (mean 2.2 vs 3.1/10). Twenty-five (21%) patients were using opioids preoperatively and 50 (42%) postoperatively. Of those using opioids preoperatively, six (24%) patients used the anti-inflammatory bundle alone and avoided opioids postoperatively. Conclusions For 58% of our patients, an anti-inflammatory bundle alone provided adequate pain control after a low-risk outpatient operation, such as hernia repair. Our practice uses the anti-inflammatory bundle for all patients. Our goal is to reduce both the need for opioids and the surgeon’s contribution to the opioid epidemic.

New Traditional Chinese Medicine Supplement Reduces Pain Faster than Conventional Pain Pills Alone: A Phase I/II Prospective, Double-Blinded Placebo-Controlled Randomized Trial

“…Indeed, multimodal therapies have become popular as a way to enhance recovery after surgery (ERAS). 13,15,16 Traditional Chinese Medicine has addressed all manners of pain management for thousands of years with success as well. Our team collaborated with specialists in Traditional Chinese Medicine to develop a proprietary multimodal herbal supplement that could be applied synergistically, similar to established ERAS protocols.…”

“…The work was inspired by the surgeons’ successful experience with a non-TCM, herbal anti-inflammatory bundle developed and used for postoperative pain control in their patients. 13 TCM ingredients were chosen based on published evidence and experience from academic TCM specialists. We sought to include agents that reduce inflammation, neuropathic pain, edema, and ecchymosis.…”

“…This regimen was continued for 5 days postoperatively, based upon the recommendation of TCM specialists who suggested that we achieve a steady state level of herbal medicine before surgery, and our experience with a non-TCM herbal regimen for acute postoperative pain. 13 All subjects were also offered or prescribed conventional analgesics for postoperative pain control, including acetaminophen, naproxen, ibuprofen, tramadol, hydrocodone, oxycodone, and codeine.…”