6 minute read
The Power to Stop Pain
Surgery is a tool used to heal our bodies. To stitch them up when they are broken, to remove foreign bodies that are making us sick. But a national prescription drug abuse crisis has many hospitals fighting to keep weapons of healing from turning into weapons of harm.
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A national epidemic
Ninety-one Americans die every day from an opioid overdose. That means that opioids now kill more people than car accidents.
The number of unintentional overdose deaths from prescription pain relievers has soared in the United States, more than quadrupling since 1999. As a result of addiction, some addicts even turn to heroin abuse when they are unable to find the pain relief they need.
These aren’t people on the streets, or junkies. These are mothers and teenagers, fathers who had back surgery and never found true relief from the pain, and even dental patients asking for one more refill.
Several factors contribute to the severity of the current prescription drug abuse problem. They include drastic increases in the number of prescriptions written and dispensed, greater social acceptability for using medications for different purposes, and aggressive marketing by pharmaceutical companies.
Hunt Regional’s medical director for anesthesiology, Romeo Baltazar, MD, is combating that epidemic locally with the use of nerve blocks and a commitment to finding new methods to combat pain after surgery.
“Every year, 33,000 die. It used to be what you call a straight overdose. Now, it’s prescription drug overdose. If you combine the use of cocaine, Fentanyl, and heroin, prescription overdose is twice as much compared to street drugs overdose. This is only in America,” said Dr. Baltazar.
Last fall the Surgeon General gave a call to action to healthcare providers, asking for help in combatting prescription drug overdose.
DR. ROMEO BALTAZAR
“One of the answers to this is to use as few opioids as possible while they are here and in the operating room. People who are depressed, abuse alcohol, or who have chronic pain, are prone to overdose on prescription medication,” says Dr. Baltazar.
“And how do we do it? By using our nerve blocks. Also, by using non-opioid medication like IV Tylenol,” he said.
“We did it to ourselves around 1990 with our vital sign measurements. We didn’t want our patients to hurt. So, what did we do? We really did a knee jerk reaction. We pumped them with all this medication. All these opioids and look what happened,” he said.
A different approach
When a patient undergoes surgery, a combination of medications— often referred to as a cocktail— may be used to sedate the patient and relieve pain. Today’s understanding of the humanbody allows for patients to be awake for many procedures. The absence of general anesthesia means a faster recovery time, less pain, and an intact immune system.
“General anesthesia depresses your immune system. By not giving the general anesthesia, your immune system stays intact so it is able to fight infection. It’s common sense,” he said.
Patient surveys at Hunt Regional typically reveal great pain management and an overwhelming appreciation for our nerve block protocol. Dr. Baltazar attributes our success to doing this differently than many organizations.
“In studies of 10,000 total knee replacements around the United States, they found that only 20% of those people who had total knee replacements had some kind of nerve block or epidural, while 80% received general anesthesia,” said Dr. Baltazar
“It is the reverse at our institution. We do around 90 to 95% epidural with our total joint replacements. Because studies have shown that when you do spinal anesthesia, it decreases the amount of blood loss. The most important thing research shows is that it decreases your surgical site infection risk,” he said.
Which cocktail is used and how long the block lasts depends on the surgery and the needs of the patient. Someone with a wrist fracture may undoubtedly have different pain relief needs than someone undergoing exploratory abdominal surgery.
By using other non-opioid medications such as antiinflammatories, Celebrex, and Lyrica, which alters how you perceive pain, the surgical team can help patients feel “normal” faster.
“Our goal is for them to be mobile right away and for them to go home and begin their therapy right away. We want to decrease the amount of time they stay in the hospital so they can be discharged right away,” says Dr. Baltazar.
Blocking out the pain
Nerve blocks are performed using the aid of ultrasound to find the nerve.
“It’s almost like a ping pong ball. You hit the ball, the ball hits the wall, and it comes back to you with a sound right?” explains Dr. Baltazar.
“That’s what it’s like. The sounds transmitted goes to a monitor and it comes out as a picture of whatever you want to see. For example, the nerve looks like white and then it’s a little bit dark at the center,” he said.
Finding the exact location of the nerve is important to make sure the relief goes where it’s needed. Before ultrasound guided nerve blocks, physicians had to rely on nerve stimulators to locate the nerve.
“Now it’s a lot safer because when you stimulate the nerve, you don’t know where you are. How close are you are to the nerve? Are you inside the nerve?” said Dr. Baltazar.
“If you can see the nerve, you can be more precise,” he said.
The injection of the nerve block happens before surgery is performed, giving the block time to go to work. By the time the patient is out of surgery, patients are in little to no pain.
The actual process of blocking the pain involves surrounding the nerve with a local anesthetic that can last up to 72 hours. Not only does this prevent pain, it also keeps surgeons from having to insert catheters which are cumbersome and increase the risk of infection.
Nerve blocks can be used for any number of surgeries including shoulder, rotator cuff, arm fractures, abdominal surgery, laparoscopy, port placement, breast surgery, and more.
“Basically you drown the nerve so it will absorb all the local anesthetic agent. By absorbing the local anesthetic, it numbs them,” said Dr. Baltazar.
He says the blocks also help your body recover faster by not introducing it to as much pain medicine which can be difficult for the body to metabolize for example, in the case of a liver transplant or a patient with kidney damage.
Part of a team
Dr. Baltazar has been part of Hunt Regional’s anesthesiology team for 10 years. He says his success is based on the willingness of a forward-thinking team.
DR. ROMEO BALTAZAR
“When I came here, I was fortunate we had people who had an open mind, and we also have surgeons that have really appreciated the technique,” he said.
Dr. Baltazar says the nerve blocks are positive tools for both the patients and the nurses.
“They don’t get called for pain. In my experience, if you practice these methods, and you do the right nerve blocks, you’ll never get called,” he said.
“You make rounds, you have to follow-up, or if the patient is an outpatient, you call them up, and ask how they are doing? They say, ‘Oh, I did great,’” he says.
Hunt Regional’s designated block area—along with the anesthesia department’s mastery of nerve blocks— has many patients choosing to stay local for surgery.
“I have surgeons that tell me, ‘Dr. Baltazar, thank you because my patient doesn’t have any pain,’” I say, ‘well, that’s what I’m here for,’” he said.
LEARN MORE ONLINE
ONLINE: www.huntregional.org/surgery
CALL: 903.408.1200
