Has A Safer Alternative To Opioids Been Found? - medtigo


Has A Safer Alternative To Opioids Been Found?

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Jonathan Akinrele, 23, underwent weight-loss surgery a little over a year ago, and he seems to be doing well after it. 

He has lost 130 pounds and avoided using opiate painkillers during his gastric sleeve surgery and rehabilitation. 

“The pain was more like a stomach ache shortly after surgery. At first, it felt a little uneasy, but it was perfectly controllable, “Akinrele, who runs a security agency on Long Island, New York, agreed. 

Due to the worldwide opioid epidemic, there is a strong effort throughout all medicine to develop alternatives to opioids. Following surgery, many patients get addicted to these powerful opioids.  

People who have weight-loss surgery may be at an even higher risk of becoming addicted. According to five medical organizations’ guidelines, including the American Society for Metabolic and Bariatric Surgery, pain management should be opioid-free or opioid-sparing during and after weight-loss surgery. 

According to Dr. Dominick Gadaleta and US News, chair of surgery at South Shore University Hospital in Bay Shore, N.Y., about 3% to 4% of people who take opioids for the first time after surgery are still taking them a year later, and this number climbs to 8% to 10% for people who underwent weight-loss surgery. 

Before weight-loss surgery, clients at Northwell Health Hospitals in New York are given intravenous acetaminophen or nonsteroidal anti-inflammatory medications (NSAIDs) instead of opioids. This is followed by a nerve block of the operative area and an intravenous infusion of non-opioid anesthetics. Northwell hospitals’ doctors have completed more than 200 procedures using this approach, including gastric sleeve surgery and hernia operations.  

Dr. Don Decrosta, chair of anesthesia at South Shore University Hospital, which is part of the Northwell Health system, noted, “We effectively turn the nerve endings down or off before surgery with preemptive acetaminophen or NSAIDs.” “When we are injured or have surgery, the nerve endings in the injured area fire significantly faster, but if we can reduce or remove this stress response with preemptive [pain management], we can get through the early healing days without using opioids.” 

Opioids block pain impulses between the brain and the body, whereas the new approach, he claims, is more targeted. 

Because they don’t need opioids, they aren’t sent home with a prescription, according to Dr. Andrew Bates, director of minimally invasive surgery at South Shore University Hospital.  

According to Bates, these people aren’t always pain-free in the days after their treatment, which is a good thing. “They could be sore afterward, which is fine since it’s a major procedure and pain can provide us with crucial information,” Bates said. “We never try to hide grief.” 

Dr. David Pechman, a bariatric surgeon at South Shore University Hospital, warned that in addition to a higher risk of addiction and overdose, opioids bring a slew of short-term adverse effects that can hinder recovery, including nausea and itching, lethargy, vertigo, and constipation. In March 2021, he was the surgeon who performed Akinrele’s gastric sleeve surgery. Opioids cause your intestines to slow down and prevent you from having bowel movements, but “with the new approach, patients have regular bowel movements and are walking around the afternoon of their surgery.” 

Weight-loss surgery patients stayed in the hospital for two to three days when Pechman was in training. He explained that most people now only stay for one night because opioids are no longer used.  

According to Pechman, people who have weight-loss surgery are more likely to develop other opioid-related issues such as trouble breathing, nausea, and vomiting. 

He noted that this is a double punch because weight-loss operations can also raise the risk of nausea and vomiting. 

For the most part, patients are on board with this opioid-reduction strategy. “Patients are ecstatic when they learn they won’t need opioids,” Pechman said, “because they often know someone who has been negatively affected or addicted to opioids or have seen what opioids can do in popular culture and on the news.” 

It’s also catching on in the United States. Many more bariatric surgery centers are following suit. “This will become standard treatment sooner or later,” Pechman remarked.  

According to Dr. Wendy King, an associate professor of epidemiology at the University of Pittsburgh’s School of Public Health, several weight-loss programs are devising their opioid-sparing regimens. “Efforts to reduce or eliminate opiate use [before and after] bariatric surgical treatment are still ongoing,” she said. 


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