C-section patients get opioid alternatives

Three hospitals aim to prevent mothers from developing addictions

Posted 1/29/19

Sky Ridge Medical Center in Lone Tree is one of three area hospitals leading the charge on using alternative pain relief methods for new mothers following C-section deliveries. Sky Ridge, along with …

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C-section patients get opioid alternatives

Three hospitals aim to prevent mothers from developing addictions

Posted

Sky Ridge Medical Center in Lone Tree is one of three area hospitals leading the charge on using alternative pain relief methods for new mothers following C-section deliveries.

Sky Ridge, along with Swedish Medical Center and Presbyterian/St. Luke's, have started offering patients the option to recover post-surgery without using opioids.

Dr. Catrina Bubier, a Sky Ridge OB-GYN, said the new methods were put to practice in response to the opioid epidemic occurring throughout the country.

“The reason pain became a problem is that (doctors) many years ago made pain a fifth vital sign,” Bubier said. “That was fine, but patients need to recognize there's going to be some pain after surgery. We don't need to get it all the way down, but you need to at least function.”

Sky Ridge began putting these into practice about eight months ago.

One alternative is called Enhanced Recover After Surgery (ERAS), which involves a different approach to post-operation pain management. The second, known as an ON-Q pump, applies local anesthetic to the affected area for up to five days of pain relief.

The ERAS process, in short, makes sure the patient is well-hydrated before the surgery and then given acetaminophen or ibuprofen afterward. Patients can drink something like water or apple juice three to four hours prior to the surgery. Most operations require patients to fast for eight to 12 hours, putting patients in a post-absorptive metabolic state, which means the digestive tract is empty and energy comes from the body's reserves. Putting the patient in an absorptive state, Bubier said, helps keep the patient hydrated, which is crucial for recovery.

Then, a non-narcotic medication is scheduled and added only as needed.

“In a metabolic (post-absorptive) state, patients starving don't have a lot of hydration and are behind the eight ball,” Bubier said, “but allowing them to have something to drink between three to four hours before surgery, your body is not so much in a breakdown state and sets it up for a better fluid status during surgery.”

The ON-Q pump administers a regulated flor of local anesthetic to the surgical site and can provide pain relief for up to five days after surgery. It is a pump attached to a catheter that is placed near the surgical area during the surgery.

The two alternative procedures are alternatives to opioid medications, which the patient still has the option of choosing. According to one study from the American Journal of Anesthesiology, 91 percent of patients coming out of C-section deliveries require opioids to cope with the pain.

These methods are being tried in several other specialties as well as for C-section patients. As of 2017, the most recent available data, nearly 50,000 people died of an opioid overdose. A study in the American Journal of Obstetrics and Gynecology said one in 300 women coming out of a C-section delivery develop an addiction to opioids.

“What's happened is there's a nationwide push to decrease opiates used,” Bubier said. “In the last year I've made a big push with my patients to let them know why we're doing what we're doing … Patients are really understanding. There's an opioid addiction problem. We're trying to prevent that from happening.”

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