Back in February, then U.S. attorney general Jeff Sessions told reporters in response to a Centers for Disease Control effort to cut prescriptions for opioids, that “people need to take some aspirin sometimes and tough it out a little.” While many took the comment as dismissive of the suffering of the 9 million Americans who take opioids every day to relieve pain, for some, the non-opioid option is a path they take to recovery.
After undergoing gastric revision and hernia repair surgery in May, Saugerties resident Jen Myer only took over-the-counter anti-inflammatory during recovery, thanks new multi-faceted opioid-free pain treatment methods at Northern Dutchess Hospital and other Health Quest medical practices, billed as “Enhanced Recovery After Surgery (ERAS).”
A 41-year-old childcare specialist, Myer is constantly chasing toddlers, picking children up from sports practices and jetting from one family to another among her group of employers. After previous surgeries, Myer had more typical convalescent periods — her tolerance for painkillers was low, she said, and her experience had “always been negative.” She said though, that her recovery period after May’s surgery was different.
“During my convalescence at the hospital, they offered painkillers. I felt so good that I rejected any painkillers at all. They would say: ‘if you don’t take them now, we can’t give them to you for another 12 hours.’ But I didn’t need to have any, or go home for any kind of prescription. Having had previous surgeries and trying to recover from having opioids and having painkillers was a struggle—they made me sick, they made me incoherent,” said Myer. “This particular surgery I was able to get up, walk, put in contacts and makeup immediately. I went to a game of bar trivia the next day, drove myself there. I felt very alert, very coherent, I felt like myself.”
Her discomfort had been quelled at its source via a Transverse Abdominis Plane (TAP) block, which consists of injecting the nerves that run through a tissue plane between two muscles with the numbing medication called Exparel to block those nerves before they reach abdominal wall. According to her surgeon, Dr. Brian Binetti, ERAS isn’t just limited to such nerve blocks — it’s a combination of techniques, employed from the consultation period to the surgery itself to the time that the patient leaves the hospital
“It involves a bunch of different components,” he explained. “Part of it is doing pre-hab on patients, meaning that we’re trying to get them into the mindset of how we are approaching their care. We aren’t doing pain-free surgery. Most of their pain will be controlled with non-narcotics in post-op, but we handle it both during and after the surgery. Before the surgery, we give them medications that are non-narcotic, non-opioid. We do the surgery, and then we do a special nerve block which lasts about three days. Imagine the numbing that you get for a cavity. The medication we use is a combination of a short-acting medication and one that works over the three days.”
Binetti said the treatment method is relatively new, and has only been employed at Northern Dutchess since early this year. He is one of over 1,100 practitioners around the country that have made the #onelesspill pledge with Plan Against Pain, an organization dedicated to promoting pain relief alternatives, affiliated with the Choices Matter initiative, a national, non-branded patient education campaign designed to inform patients about effective non-opioid options available to manage surgical pain and activate patients to feel empowered to proactively discuss these options with their clinicians. The program is sponsored by Pacira Pharmaceuticals and has the support of numerous partners, including Shatterproof, the American Society for Enhanced Recovery and ZeroLeft. Last week, the organization filmed Myer for a testimonial video that will be shown to patients considering ERAS.
“We were impressed with Jen’s recovery following her surgery and chose to spotlight her story on PlanAgainstPain.com as a way to educate all individuals planning for surgery that there are effective non-opioid options available to help manage postsurgical pain,” explained Dave Stack, CEO of Pacira. “Non-opioid options, including the long-acting liposomal formulation of a local analgesic Dr. Binetti used for Jen, have been successfully used across a wide range of procedures including joint replacement, plastic surgery, abdominal and weight-loss procedures.”
His relationship with the organization, he said, was borne out of his usage of the drug exparel in the procedure, a burgeoning non-opioid drug called liposome bupivacaine and classed as a “sodium channel blocker” used to perform nerve blocks. Binetti works with the company to teach other doctors to inject the medication properly.
“[Plan Against Pain] was in line with what I was trying to do in terms of taking an approach that’s multimodal versus saying that one medication should do the whole thing,” he said of his involvement with the organization.”
Although the ERAS method is still in an emergent stage, Binetti said that we should expect to see if offered in hospitals around the country more frequently in coming years. However, the method is still being improved with each patient.
“I think we hit a critical period with the opioid epidemic and with overdoses. Even Trump is talking about doing something. Not that, doctors or medicine are the sole source of opioids, but we can play a part. As our technique becomes less invasive and our approach becomes more holistic and expansive, it makes sense that it will become easier and easier not to employ opioids before and after surgery. There’s definitely a wave rising, coinciding with the opioid epidemic. Simultaneously, during the surgery itself we are trying to figure out ways that we can get patients back to normal more quickly, and that is all part of what we call enhanced recovery. As we were improving our enhanced recovery, we wanted to see how far we could take it while being opioid-free. Enhanced recovery is pushing its way through, and I think there’s a push as well to limit the amount of narcotics and opioids we’re using.”
Before approaching Binetti for her procedure, Myer was unaware of a recovery option for surgery that didn’t involve a pain pill prescription. Now, months after her procedure, Myer wouldn’t have done it any other way.
“I feel strongly about having a non-opioid surgery. It enhanced my recovery, Dr. Binetti, I trust in his judgment, I trusted him to do the best with his patient, who was me, and I trust the results. It was all good stuff. There was no downside, there was no con for me, personally, in having non-opioid surgery. I’m happy that a local hospital is offering such a cutting-edge, progressive option to their patients that will benefit their recovery or treatment.”