Orthopedic Surgery Team Promotes Opioid Safety with New Guideline
Earlier this year providers in Lurie Children’s Division of Orthopaedic Surgery & Sports Medicine, led by Dr. Craig Finlayson, Dr. Erik King and Dr. Neeraj Patel, developed a new pain management algorithm for patients following orthopedic surgery.
The team’s goal was to minimize the use of opioids altogether, but also to decrease the variation in the types, dosage and duration of opioids prescribed, and to increase patient education on the topic.
The multifaceted algorithm, developed after reviewing literature and combining expertise on multi-modal pain management, involves the following:
- Opioid-sparing for lower acuity surgeries
- Standardized the type of opioids, dosing regimen and duration of prescription for higher-acuity surgeries
- Discontinue use of drugs combining opioid and acetaminophen to allow for consistent use of acetaminophen without risking overdose
- Optimized use of multi-modal anesthesia
- Regular dosing of ibuprofen and Tylenol post-op
- Encourage use of regional/neuraxial anesthesia
- Encourage use of non-opioids such as gabapentin and diazepam to reduce neuropathic pain and muscle spasm
- Encourage use of cryotherapy and other non-pharmacologic strategies
- Developed protocols for patients able to swallow pills and those who are unable to swallow pills
The team developed new order sets in the electronic health record used at Lurie Children’s along with new patient education materials on pain management. They then educated their fellow providers, including nurses and members of the surgical team on the new algorithm.
Dr. Finlayson said he and colleagues plan to track prescription patterns and refill requests along with visits to the ED and clinic for pain concerns to confirm the effectiveness of the new protocol.