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SALT LAKE CITY — Dixie Regional Medical Center has been working to shift post-surgical pain management away from opioids and toward regional anesthesia, with more Intermountain Healthcare hospitals to soon follow suit.
Dixie Regional instituted a program about 10 years ago to help prevent overuse of opioids and manage chronic pain, according to Dr. Reed Y. Nelson, medical director of the Acute Pain Services at the hospital. The program is called the Regional Anesthesia Acute Pain Service (RA-APS) and is currently used to provide care to more than 33 percent of the hospital’s surgical cases (500 patients per month).
"The opioid crisis has finally received long-overdue attention due to the debilitating and often dangerous side effects of opioid use," Nelson said. "Regional anesthesia and peripheral nerve blocks are a way to prevent the need for opioids."
He added that in 2015 Utah ranked second in the nation for overdose deaths from prescription opioids. He believes that regional anesthesia can help solve this ever-present problem.
Kristi Van Dam, the nurse manager at the Acute Pain Service in Dixie Regional, told KSL.com that the goal for regional anesthesia is to help prevent this chronic opioid abuse.
“When educating patients we often liken it to what happens when you go to the dentist,” Van Dam explained. “When you get a tooth worked on they will numb that area of your mouth so that you can’t feel it, and then they'll do the procedure. If we know you’re going to have a procedure that we expect to be painful, we can implement regional anesthesia as an option.”
Regional anesthesia, also known as a “nerve block,” blocks sensations in specific parts of your body during and after surgery, according to the University of California San Diego Health. It is injected around nerves that transmit pain sensation, silencing them so they temporarily don’t indicate that the body is in pain to the brain.
"These blocks can numb the surgical site for up to five days post-operation by strategically placing peripheral nerve catheters next to a nerve and then continuously infusing numbing mediation," Nelson said. "These nerve catheters can be taken home and are 100 percent disposable, so the patient can remove them well after they are discharged from the hospital."
The purpose and benefit of these nerve blocks are to numb just the part of the body that has pain from surgery, according to Nelson. Instead of taking high doses of opioids that affect the entire body and have debilitating side effects, the patient can have just the leg, abdomen or shoulder numbed with a peripheral nerve block.
"Peripheral nerve blocks have (been) shown to improve pain control, shorten hospital stays and increase patient satisfaction," Nelson said. "Other benefits of regional anesthesia include less nausea after surgery, improved bowel function, fewer blood clots and greater mobility after surgery."
The goal is not to completely eliminate opioids, but to make them less necessary so that patients don’t need to take as much, thus limiting their risk of opioid addiction.
“Typically, regional anesthesia is used not to eliminate all pain but to decrease it to a point where a patient could take significantly fewer opioids,” Van Dam explained. “They are working together and both treat pain in a different way. Patients who utilize regional anesthesia in addition to the opioids feel better than the patients who would just take opioids.”
Van Dam told KSL.com that so far, within Intermountain in Utah, they have seen the lowest opioid use in their total knee replacement program. “Our patients use fewer narcotics than any other hospital,” she said.
"Dixie Regional Medical Center performs the highest number of total joint surgeries in Utah," Nelson said. "Over 95 percent of our total joints receive (regional anesthesia). So patients can have a total knee replacement without needing any opioids during surgery. The peripheral nerve block is in place for five days after surgery and some patients require only acetaminophen and ibuprofen to treat their pain." Intermountain is currently working to implement regional anesthesia practices throughout all of their hospitals as quickly as possible, Van Dam added. Currently, five hospitals on the Wasatch Front have established Acute Pain Service programs with plans for several more in the works.
Over the past 20 years, regional anesthesia has become safer and more acceptable as a medical treatment, according to Van Dam. The decreased risks associated with it and the increased risks of opioids motivated providers to spend more time looking into pain management alternatives.
“Intermountain has taken a stance on opioids and has made it a goal to reduce the amount the medications are prescribed,” Van Dam said. “To my knowledge, they’ve met all those goals. Physicians have been prescribing fewer opioids and are now searching for alternatives.”
This is certainly true for Nelson and other physicians at Dixie Regional Medical Center.
"Today, we perform opioid-sparing regional blocks on over 450 patients a month," Nelson said. "That is over 33 percent of all surgical cases done at Dixie Regional Medical Center. We now have over eight nurses that assist with block placement and educate both patients and staff about non-opioid pain management."