“Opioid-free”: Innovative ACL Surgery That Doesn’t Rely On Opioid Pain Pills

WellSpan Health finding a better way to manage pain and avoid potential addiction

York, Pa., June 09, 2022 (GLOBE NEWSWIRE) -- A WellSpan orthopedic surgeon is performing surgery on all patients under the age of 25 without prescribing opioids, just one method WellSpan caregivers are using to reduce the exposure of patients and families to narcotic drugs in light of the country’s opioid crisis.

“Eliminating opioids after surgery is definitely a trend and a push in orthopedics in general,” said WellSpan orthopedic surgeon Dr. Michael Day said. “There is an awareness of how problematic opioids have been for our society, and a lot of people are happy not to introduce them in their care.”

Across the system, WellSpan surgeons, nurses, and anesthesiologists work as a team to offer effective, safe, post-surgical pain control, replacing the use of opioids with other treatments. Since 2019, WellSpan clinicians have focused those efforts on cesarean sections, hernia repairs, gallbladder surgeries, spinal fusions, and total knee and total hip replacements. For those procedures, WellSpan’s team has decreased opioid use by 46 percent since 2019, a decrease equivalent to more than 141,000 5 mg oxycodone tablets now not being prescribed.

Day prescribes other pain relief methods for his young surgery patients, including a medicine that decreases inflammation, a nerve medication, over-the-counter Tylenol, and the use of an ice machine after surgery.

Two of Day’s patients include Brandon Vaughn and Carter Flory, who were Chambersburg High School football teammates. The two teens had surgery on the same day last fall to repair torn ligaments in their knees.

Brandon and Carter (who later underwent a second surgery due to the extent of his ligament tears), both had some pain and a few uncomfortable days after their surgeries but the ice machine and the Tylenol helped. They also began physical therapy at WellSpan Results Fitness in Chambersburg promptly after their operations, which helped them to get on their feet again.

 “I feel like I’m back to normal,” Brandon says. “The only reminder I had the surgery is the scar. I’m glad I got through it without having to use opioids.”

Day first began foregoing opioid prescriptions for patients under the age of 25 undergoing a repair of a torn anterior cruciate ligament (ACL), a key ligament in the knee joint that is at risk of tears in athletes who do start-and-stop movements in sports including football, soccer, and basketball. Seeing the success of that, Day extended the practice to all ACL patients and then to all orthopedic patients under the age of 25, including those who undergo shoulder or kneecap stabilization surgery, among other procedures.

Day used to routinely prescribe 30 opioid pills to patients for pain control after surgery. He started tracking how many patients took and found it was less than half, so he reduced his prescriptions to just 15 pills. He noticed teens took even fewer pills, maybe just one for the first therapy session.

“They would realize they didn’t really need it,” he said. “They were taking really low numbers and probably just because it was prescribed, not because they really needed it. And they are at the highest risk for exposure to something that could later be an addictive medication.”

Day tells patients if their pain feels unmanageable, they can call him for help and a stronger prescription. But during the past year, no one has called.