The Arm-Wrestle Over Opioids in the Operating Room

The Arm-Wrestle Over Opioids in the Operating Room 1

Yves here. While the plural of anecdote is not data, I am very much bothered by the very strong “one size fist all” bias of this article, which was originally titled, “Why opting out of opioids can be dangerous in the operating room.”

The authors take the position that patients must be rendered unconscious for procedures. That is abjectly false. The overwhelming majority of patients no doubt prefer that but it wildly misleading to assert that it is necessary, unless the real objective is to have the patient unable to hear and recall what the surgical team says while they are working.

I have had two procedures in the last year. One was a bilateral hip replacement at the premier orthopedic hospital in the US, New York City’s Hospital for Special Surgery. They pioneered doing hip replacements with epidurals rather than general anesthesia. That is now standard since recovery times and surgical outcomes are better. Epidurals use mainly or entirely local anesthetics like bupivacaine, chloroprocaine, or lidocaine. Most patients want twilight sleep with that but the hospital has a few weirdos every year like me who want to stay awake and they are fine with that.

For a much less dramatic procedure, a D&C, I had to shop to get a surgeon who was willing to do it with a local only (this procedure can often be done in office, but the surgeon tried and was unable to do so, so we had to reschedule for an outpatient hospital procedure to get access to heavier-duty equipment, which meant she and I were hostage to hospital bureaucracy). The surgeon was confident I’d be fine (and I was) but the anesthesiologist worked on me hard, even right before the procedure, to get me to have twilight sleep, which I refused. Frankly, I would have been very anxious about the prospect of having someone operate on me when I was knocked out (it seems like rape) while I wasn’t nervous before any of my procedures.

Of course, an entirely separate issue is that opioids do almost nothing to reduce my pain and they make me feel terrible.

But this is separate and apart from my view that anesthesiologists want patients heavily sedated because they are less trouble that way, and thanks to pulse oximeters, anesthesiologists can safely sedate patients more heavily than in the past.

By Mark C. Bicket, Co-Director, Opioid Prescribing Engagement Network and Assistant Professor, University of Michigan; Jennifer Waljee, Associate Professor of Plastic and Reconstructive Surgery, University of Michigan and Paul Edward Hilliard, Clinical Associate Professor of Anesthesiology, University of Michigan. Originally published at The Conversation

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