Prepare Patients
- "We want you to be as comfortable as possible after your surgery"
- "Your body will need time to heal"
- "If it feels like something is wrong, you can always check with us"
Make a Plan
"Have you had surgery before? … What did you do for the pain after your last surgery?"
This may reveal a story of problems with pain relief, which ought to give a surgeon pause for discretionary surgery. When surgery can't be delayed, be prepared to get help: addiction or psychiatry consults; preparation for difficult discussions. Another red flag: lack of awareness of the opioid epidemic.
- Postpone discretionary surgery
- Work with PCP (and any other relevant care providers) on a plan
- Consider screening for depression, ineffective coping strategies, and propensity for opioid misuse (using the Opioid Risk Tool, or SOAPP)
Most patients will say, "I took a few opioids and then switched to Tylenol or Motrin"
- Reinforce that. Emphasize opioids for the first 24-48 hours, perhaps mostly for sleep and then rapid transition to non-opioid pain relievers.
- Make a plan for pain relief.
- Determine their preferences for non-opioid pain relievers. Emphasize that one can take Tylenol and NSAIDs simultaneously as they do not cross-react.
- Worry less about using NSAIDs than opioids. A recent review shows no clear effect of NSAIDs on bone healing.
- Discuss which opioid and how much will be given.
- Discuss opioid safety
- "Are you aware of the opioid epidemic?" (lack of awareness may be a red flag—see above)
- Tell them how to dispose of unused medication (see safety handout)