ERs and Hospitals Search for Alternatives to Opioids

ERs and Hospitals Search for Alternatives to Opioids

A 53-year-old car crash victim, suffering unimaginably intense pain from a thigh so badly shattered that pieces of bone were sticking out, begged doctors at a Baltimore, MD, trauma center recently to not give him opioid painkillers. The patient's surprising refusal to accept the standard treatment for such cases was a simple and powerful message. He was a recovered opioid addict, he explained, and didn't want to risk a relapse. Years earlier, another car crash had led him to a pain clinic that prescribed Percocet "just like candy. I can't lose what I worked for," he said. The doctors listened and came up with an alternative, non-opioid pain treatment. And according to the recent Associated Press (AP) article that reported on the crash victim's plea for no opioids, there's something of a movement going on to find new ways to deal with trauma pain. According to the AP story, the patient was lucky to have arrived at the University of Maryland Medical Center, where alternative treatments for pain were being researched and applied already. The physicians came up with a brilliant solution, "an ultrasound-guided nerve block bathed a key nerve in local anesthetic, keeping his upper leg numb for several days." The treatment managed the patient's pain and "dramatically cut his need for opioids" during and after his surgeries, hospital stay and subsequent recovery.

Opioid epidemic forcing a new look

A Harvard study in the New England Journal of Medicine suggests that one out of every 48 patients prescribed an opioid in an ER uses the pills for at least six months over the next year. "And the longer they're used, the higher the risk for becoming dependent," the story said. The current opioid addiction and overdose epidemic is inspiring many hospitals and trauma centers to look for new ways of managing pain "without using the opioids that have long been the mainstay for the severe pain of trauma and surgery," AP said. Trauma specialists, surgeons and anesthesiologists don't want to "save patients' lives or limbs only to have them fall under the grip of addiction." Trauma anesthesiologist Dr. Ron Samet, who treated the patient with the shattered thigh, said the innovative nerve block "cut by tenfold the amount of opioids he'd otherwise have received for his latest injury."

Fast and effective no-risk treatment

The treatment requires somewhat specialized skills that aren't usually part of a family doctor's bag of tricks. But it's not rocket science, either, and can be applied quickly and effectively by a skilled and experienced anesthesiologist such as Dr. Samet. He wheeled over a portable ultrasound machine beside the victim, placed a probe over the patient's pelvis and located three tiny dots on the video screen that mark key nerves. He then threaded a tiny tube directly to the nerves, which was used to infuse a non-addictive numbing medication for three days. "It has really changed the dynamics of how we care for these patients," Dr. Samet said. "It's like a godsend," the patient said later. "If you can have something like this, why would you want to take anything else?" He said that a day after having a steel rod implanted in his femur (thigh bone) to stabilize it, "I can wiggle my toes, I can move my foot, there's feeling right above the ankle." But in that damaged thigh? "I can't feel anything." Roughly 2 million people are addicted to opioids in America and an average of 91 Americans die every day from opioid overdoses - either heroin or prescription opioid painkillers. It should be kept in mind that prescription opioids are what have very likely led to most heroin addictions in this country.

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