How Can We Reduce Opioid Use Pre- and Postsurgery in Orthopaedics?

With the opioid crisis affecting thousands of Americans, what is the Department of Orthopaedic Surgery doing to reduce narcotic use?

First of all, Cleveland Clinic as an institution offers tremendous educational opportunities regarding opioid use that almost all practitioners have attended. This is part of onboarding for new staff and continuing education for others, and it is a major institutional initiative.

We hear the numbers: one person dies every 19 seconds in the United States from a narcotic or a narcotic-related overdose, and that the great majority of these are postsurgical.

Our department is making a full force effort to reduce opioid use in patients, both before and after surgery, attacking the problem on multiple levels. We have launched a number of studies designed to help us reduce opioid use. This includes preparing a number of new studies with various industry partners, as well as government-supported studies with NIH and other agencies like PCORI, the Patient-Centered Outcomes Research Institute.

I was the lead author of a 14-center study published just a few weeks ago where we used the long-acting anesthetic agent liposomal bupivacaine injected during knee replacements. These procedures are among the most painful operations that any of us perform in any specialty. The study showed a reduction in opioid use in patients who received this long-acting agent compared to the control group, which received the standard non-long-acting bupivacaine. There were about 80 patients in each group. In the long-acting group, 11 patients required no opioids whatsoever after knee replacement, versus none in the control group. It was dramatic.

We are instituting the use of liposomal bupivacaine for all knee replacement patients as a result of the study. Awareness of the opioid epidemic had led to an across-system decrease in opioid prescriptions. I’m satisfied that our efforts are moving in the right direction.