New Pain Reducing Procedure Studied by ONS Orthopedic Surgeons

Posted on October 3, 2016

Greenwich orthopedic surgeon Dr. Paul Sethi and the ONS practice were featured in an article in Greenwich Patch for using a new pain-reducing procedure that can reduce or eliminate the need for narcotics.

In the article, Greenwich Surgeon Strives to Combat Opioid Epidemic with New Procedure, Greenwich Patch staff writer, Rich Scinto, wrote that oftentimes opioid addiction begins after surgery. 

Following is the article in its entirety:
Opioids post-surgery have become a double-edged sword in the wake of an increasing addiction epidemic. While they have great pain-reducing powers, they also carry the risk of addiction and the chance that pills can fall into the hands of an addict.

A group of orthopedic surgeons based in Greenwich are using a new pain-relieving method that helps reduce a patient’s reliance on opioids.

Dr. Paul Sethi with Orthopaedic and Neurosurgery Specialists recently has seen collegiate athletes in need of surgery who are willing to suffer great amounts of pain if it means staying off of opioids post-surgery.

“Young people are becoming more aware of how dangerous of a problem it is,” Sethi said about opioid addiction.

It is also frightening as a surgeon to think that an opioid prescription that is intended to help a patient recover could lead to death or a lifelong battle with addiction, he said.

Sethi has been performing shoulder replacement surgeries with the use of Exparel, which is an injection of long-lasting liposomal bupivacaine that can last for three days post-surgery. Some patients have used no narcotics or a greatly reduced amount after the surgery, Sethi said.

Instead of prescribing 30 narcotic pills post-surgery generally there is only a need to prescribe 10, he said. That translates to less pills that could fall into an addict’s hands.

The prescription of opioid pain relievers has skyrocketed. In 2013 health-care providers wrote 259 million prescriptions, enough for every American adult to have a bottle of pills, according to the CDC.

About 70 percent of opioids used for non-medical reasons are obtained through family or friends and 18 percent through a prescribing doctor, according to the Substance Abuse and Mental Health Services Administration.

Sethi and others are conducting a peer-reviewed study about Exparel’s effectiveness in reducing pain after surgery.

Sethi and others at the practice plan to expand the use of Exparel to other types of shoulder surgery and there is potential to use it in operations such as ACL repairs. The injection has to be specifically tailored to each surgery in order for it to be effective, he said.

Surgeons should spend a good amount of time educating their patients about pain management and the potential for opioid abuse.

“In medicine we are pressed for time, but I think this is one of the most important things we teach our patients about,” he said.

The injection costs about $300 extra, which is a bargain if it can save a person from an overdose death or a long struggle with addiction, Sethi said.

For now narcotics still are prescribed in case pain comes back after Exparel wears off.

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