Episode 6: Opioid-Free Surgery: One Patient’s Story

Wendy Nickel: Thank you both for being here today to share a little bit about your surgery story. My name is Wendy Nickel. I'm the president of the Healthcare Improvement Foundation and I have a deep background in shared decision making between patients and clinicians. I'm really excited to speak with both of you and better understand what led you to the idea of opioid-free surgery and that's what we're going to be talking about today. I would love it if you would introduce yourselves. Starting with Dr. Bar, if you could share a little bit about you and your background, and then we'll go to Donielle.   Dr. Allen Bar: I'm Allen Bar. I was a surgeon at Pennsylvania Hospital. Retired about a year ago. I've been in practice for 47 years doing general surgery, primarily breast, GI surgery, and hernias.             Starting in 2015—in answer to your question about how I got interested—three of us got involved with enhanced recovery. I was the surgeon. The other two were quality nurses who were involved in quality and data. And we realized that there were some issues at our hospital as far as data was concerned. I had heard a lecture on enhanced recovery and felt that this was something that we should do. And a big part of enhanced recovery is non-opioid analgesia and anesthesia. And that when I got really involved.             At a personal note, I've known for 20 or 25 years that I cannot come near an opioid, even something as little as low modal, without getting violently ill. And making it personal, I've tried to figure out if I needed any major surgery, what are the alternatives? Well, enhanced recovery gave us that and in my practice the last five, six years, even more than that I have pretty much eliminated opioids from my postoperative care.   Wendy Nickel: Great. Thank you, Dr. Bar. Donielle, would you provide an introduction please?   Donielle Calabrese: Hi, good afternoon. I'm Donielle Calabrese and I was a patient of Dr. Bar's in 2018. I had a hernia repair and I knew of Dr. Bar and sought him out to do my surgery—one of the reasons being he's an excellent surgeon, but also I knew that he did not prescribe narcotics and in the past I did not do well with opioids. I tend not to take them anyway. So sometimes I'm prescribed yet I don't even get them filled.             So my professional background is I am a registered nurse in the University of Pennsylvania health system. And I've been a nurse for 29 years. And right now in the last 10 years I've worked in the recovery room, so I recover patients from surgery. Prior to that, I worked in an ED for 10 years. Before that it was in surgical units. I have a lot of background with pain management.   Wendy Nickel: Great. Thank you, Donielle. So Dr. Bar, turning it back over to you, can you tell us a little bit about the procedure that Donielle required?   Dr. Allen Bar: Well, I do open hernia repairs. And as you may or may not know, in the past we used to give 40 Percocets for this. Realizing that this was not the way I wanted to go. As I say, it's an open hernia repair. It is "theoretically" very painful... I operate on Tuesdays and I will say to the patients, "You will not like me until Thursday afternoon."             And I hate to use the word pain. Pain implies something bad, and I much prefer to use discomfort. So I talk to the patients about surgery does hurt and they'll be uncomfortable. And we give them pre-op Tylenol. Intraoperative we give them Toradol. And I use Marcaine and ice on their wound, all of which have shown to decrease "pain" or discomfort. Then they go on every three hours Tylenol and ibuprofen alternating. I have had over a hundred patients in this and I think maybe two or three have called and asked for any kind of narcotics and I usually give about two or three pain pills. So it's been very successful. Most of my patients I do talk to beforehand, like Donielle, as soon as I say I don't use narcotics, they smile and say, "I don't want them."   Wendy Nickel: Thank you. Donielle, can you talk a little bit about how you did after surgery with the opioid free techniques. How did you feel in the days post surgery and throughout your recovery?   Donielle Calabrese: I did very well. I will tell you Dr. Bar did call me the next day. That evening of the surgery. I did take Motrin and Tylenol. The next day I remember talking to Dr. Bar and I said to him, "I haven't taken anything." And he's like, "Well, maybe you should take a little bit of Motrin at least or something so you don't have discomfort and that you can move around better." But I honestly felt like I didn't need anything. And I only took it because he told me to take it. I probably wouldn't have taken the Tylenol and Motrin either.   Dr. Allen Bar: If I may also, three years ago I had my hernia fixed. And again, I did not take any opioids and it was done on a Thursday and by Friday I wasn't taking anything and I had ...