Better pain relief speeds recovery after colorectal surgery

As we’ve seen from the much-reported rise in abuse of prescription opioids, use of the painkillers can be fatal when not properly managed.

But even under the careful supervision of a physician, opioid use can cause a less severe problem – opioid-induced constipation, leading to delays in a patient’s discharge after surgery.

Now, UCLA physicians from several departments have collaborated on a new regimen to manage pain using fewer opioids while speeding recovery of patients before, during and after colorectal surgery. It’s part of a larger enhanced recovery program for these surgery patients at Ronald Reagan UCLA Medical Center.

“We always strive to keep patients as comfortable as possible when they’re in the hospital, and allow them to return home to their families as soon as possible after surgery,” said Dr. Aman Mahajan, chair of the Department of Anesthesiology and Perioperative Medicine at the David Geffen School of Medicine at UCLA.

The pain-management protocol took shape after surgeons realized that some patients were staying in the hospital longer than average after surgery on the colon, small intestine or rectum because they were slow to recover bowel function.

Physicians identified the chief culprits as morphine, Dilaudid and other narcotics that help manage post-operative pain but may result in opioid-induced constipation.

Surgeons and anesthesiologists – led by Dr. Anne Lin, an assistant professor specializing in colon and rectal surgery, and Dr. Maxime Cannesson, vice chair for perioperative medicine – developed a plan to reduce the prescription of opioids through the use of local anesthetics in combination with an ultrasound-guided nerve block, and acetaminophen.

The result: In a pilot study, patients on this pain management regimen recovered bowel function up to two days earlier than patients who received the usual medications.

The enhanced recovery program – which includes pain management techniques as well as many other elements – has now expanded beyond the pilot phase.

Get more information on the program on the Department of Anesthesiology & Perioperative Medicine website.


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