Posted on October 28, 2016

Opioids after orthopedic surgery could become a thing of the past.

Recovery from total shoulder replacement surgery usually includes weeks of excruciating pain.  This was not the case for Manhattan, NY resident, Marjorie Purnick, 71, who was out to dinner with surgeryfriends the night after Dr. Paul Sethi performed the procedure using a new, slow release analgesic called Exparel.  Marjorie said she has never taken a single pill for pain in the four months since her shoulder replacement surgery.

“It was incredible. I kept waiting for the pain to hit, but it never did.  Friends who have had the same surgery don’t believe me when I tell them that I had no pain,” she said.   With the help of physical therapy, Marjorie has regained close to 100 percent of her range of motion, a recovery that she said is 4 to 8 months quicker than her friends. “I think I’ve recovered so quickly because I didn’t have pain holding me back.  I could get started with therapy right away.”

As soon as 49 year old Michele Herrera of Rye, NY heard about this new pain treatment, she asked Dr. Sethi to use it during her surgery to correct torn biceps and bone spurs in her right shoulder.  Vivid memories of the agonizing pain she had endured following a similar surgery on her left shoulder five years ago had been preventing her from undergoing the procedure again.
“I was petrified to have the surgery again because of that pain,” she recalled.  This time around, however, it was completely different.  “I am the happiest person in the world.  I had surgery on Thursday and I was out walking the dog that same day.”  When the medication did start to wear off 4 days later, she said she took pain medication because she afraid of how intense the pain would be. She was pleasantly surprised. “I only took one pill instead of two, and once I realized that I only felt a little sore, I switched to Tylenol.”

The search for an alternative to opioids at ONS is borne from a real concern about the increasing national opioid addiction epidemic and the role prescribed opioids like oxycodone and hydrocodone play in addiction. Every day, 78 Americans die from an opioid overdose, according to The Centers for Disease Control and Prevention.  Since the late 1990s, the number of deaths from prescription opioids has quadrupled.

“It is frightening as a surgeon to think that an opioid prescription that is intended to help a patient recover could lead to a lifelong battle with addiction or death,”  said ONS orthopedic surgeon, Paul Sethi, MD.  He has seen college athletes in need of surgery who are willing to suffer great amounts of pain if it means avoiding opioids post-surgery.

Dr. Sethi and ONS colleagues Seth Miller, MD, Katherine Vadasdi, MD and Marc Kowalsky, MD, have been performing shoulder surgeries with the use of  this new analgesic,  that is injected directly into the surgical site and numbs the area for three days or more.  Some patients who have been administered Exparel have not needed any narcotics for pain, or if they did, they’ve needed far fewer than with traditional post-surgical pain control, Sethi said.

“When patients need additional pain relief instead of prescribing 30 narcotic pills post-surgery for instance, there is only a need to prescribe 10,” he said.

Moreover, patients are able to regain movement more quickly because they are not consumed by pain.

Physicians at ONS are optimistic that as more non-narcotic methods of pain relief are made available, the number of prescribed opioids for surgical pain will plummet.  Sethi and others in the practice are conducting a peer-reviewed study about Exparel’s overall effectiveness in reducing pain after other types of surgeries. “The injection has to be specifically tailored to each surgery in order for it to be effective,” Dr. Sethi said.
They plan to expand its use for other surgical procedures such as repairs to ruptured anterior cruciate ligaments (ACL).
Currently, 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.