Recover from orthopaedic surgery with minimal opioid use

Large amounts of opioids prescribed for pain following surgery were once the norm, but orthopaedic surgeons today are increasingly focused on developing strategies to limit opioid use and related consequences, including high rates of addiction and other physical risks.

Endeavor Health orthopaedic surgeon and sports medicine specialist Joseph Lamplot, MD, highlights the successful approaches he and his colleagues use to help patients recover from major surgery with little or no opioid use.

Prepare your body for better healing

Preparing your body before a scheduled surgery is a crucial step for a successful recovery.

1. Eat healthy. Dr. Lamplot recommends focusing on nutrition by eating a healthy, high-protein diet. "We know that you heal better when you have adequate amounts of protein, which is key to musculoskeletal health," he said.
2. Get enough vitamin D. Ensuring that you have sufficient levels of vitamin D is also important and helps ensure bone and ligament strength.
3. Adopt healthy habits. Maintaining a healthy weight and quitting smoking if you smoke are vital ways to optimize your wellness before surgery.
4. Get as strong as possible. Working to get as strong as possible prior to procedures including joint replacements and ACL reconstruction will lead to a much easier recovery, which likely means less pain management needs, said Dr. Lamplot. "For many procedures, we set patients up with physical therapists well ahead of time, weeks or even months before surgery to optimize their strength and function ahead of surgery," he added.

Realistic pre-operative expectations

Dr. Lamplot emphasizes that in-depth conversations with patients and their families are essential for setting realistic recovery expectations, helping them manage pain effectively with little to no opioids for most procedures.

"We've found that when patients and their family members helping to care for them understand and expect there to be some pain after surgery, they consume less pain medication," he said.

For example, when he counsels someone going in for rotator cuff surgery Dr. Lamplot lets them know that their recovery will definitely not be pain-free.

"Expect to have pain around an 8 (on a one to 10 scale) and we want you to bring it down to a 6 with medication," he said. "Back in the 90s, we used to talk about pain like a vital sign and we told patients to 'stay ahead of it' with pain meds. But I don't want you taking opioids/narcotics if you don't have pain."

Research and literature have proven that pre-operative counseling and education around pain dramatically lessens opioid use, he added.

Multi-modal pain control

Dr. Lamplot and his Endeavor Health colleagues use a multi-modal approach for pain control in major procedures, starting with a peripheral nerve block in surgery that numbs the nerves in the procedure area and gives very good pain relief for 18-24 hours. "The most pain typically happens the day after surgery when the nerve block starts to wear off," he said.

Patients are also given anti-inflammatory medications and Tylenol for further pain control, and then are sent home with a dedicated array of medications with clear instructions on exactly when to take each medication and a brief description of what each medication does.

A 6-day course of oral steroids after surgery helps reduce inflammation and pain, and has proven to be a game changer for many, said Dr. Lamplot.

In addition, he also gives patients instructions for around-the-clock Tylenol use, which is very effective in conjunction with rest of the protocol that includes steroids, aspirin for blood clot prevention, and anti-nausea medication.

Patients are also given a few tablets of an opioid-like painkiller for breakthrough pain (tramadol), as well as a few tablets of oxycodone for pain uncontrolled by all of the other medications.

"Our protocols are continuing to evolve as we work collaboratively across specialties toward our goal of opioid-free surgical recovery," said Dr. Lamplot, whose research and quality improvement work focuses on reducing postsurgical opioid use.