ONS Dr. Paul Sethi and the ONS Foundation- Leaders in Research to reduce the use of Post-Operative Narcotics

According to the Substance Abuse and Mental Health Services Administration, 70 percent of the drugs used for opioid abuse are obtained from family or friends, and 18 percent are prescribed by a doctor to manage symptoms of pain. It is now well known that there is an increased risk to patients of developing an opioid addiction as the result of using narcotics after undergoing a surgical procedure.  Dr. Paul Sethi and other orthopedic surgeons are now using a new pain-relieving method during surgery that has is significantly reducing in the need to prescribe opioids following surgery. 

Dr. Sethi says he has seen collegiate athletes undergoing surgery who have elected to suffer a high level of pain to avoid using opioids post-surgery fearing the risks.  “Young people are becoming more aware of how dangerous of a problem it is,” Sethi said about opioid addiction.  “As a surgeon, it is also frightening to think that an opioid prescription intended to help a patient recover could lead to death or a lifelong battle with addiction”.

Sethi has been performing a variety of shoulder surgeries including shoulder replacement with the use of a medication called Exparel.  This relatively new pain medication is injected into the surgical site in strategic locations during surgery, and it’s pain relieving benefits can last for up to three days after surgery. Many patients have used no narcotics at all or a greatly reduced amount after the surgery according to Sethi.

Prior to having Exparel it was not uncommon for orthopedic surgeons to prescribe 30 narcotic pills post-surgery. Now we generally prescribe 10 and less, says Sethi. And often patients report that none are needed at all. That also means less pills are at risk of falling into the hands of others. Roughly 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 his colleagues have conducted a peer-reviewed study about the effectiveness of Exparel in reducing pain after surgery that has now been published in the Journal of Shoulder and Elbow Surgery; Opioid requirement after rotator cuff repair is low with a multimodal approach to pain.   

Sethi and his colleagues at ONS have expanded the use of Exparel to other types of surgeries including ACL repairs.  He also advocates that surgeons should spend a good amount of time educating their patients about pain management and the risks for opioid abuse.He says, “this is one of the most important things we need to teach our patients about.”