complete a 10-day course of
opioids begin to show signs of
addiction. And though they
may be cheap up front, once
you consider the loss of life,
the economic impact of sub-
stance-abuse disorder and the
cost of managing addiction,
they're tremendously expen-
sive to society — much more
expensive than the alterna-
tives.
Fortunately, times are chang-
ing. I used to feel like a lonely
voice in this battle. Now,
there's a large cadre of opioid-
sparing surgeons who are more than willing to have this essential con-
versation. And every day, more surgeons are converting.
An awakening
Now for the slightly controversial part of my story. In addition to
becoming aware of breakthroughs in multimodal pain regimens —
combinations of non-opioid medications that target specific pain path-
ways — the turning point for me came when my partner, David
Prybyla, MD, told me about a journal article he'd read on liposomal
bupivacaine. (He reads a lot more than I do.)
I know what you're thinking. And it's true. Liposomal bupivacaine
(Exparel) has become the licorice — or maybe Grateful Dead — of
the medical world. You either love it or you hate it. I'm keenly aware
that of the thousand or so journal articles that have been written
3 6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • F E B R U A R Y 2 0 1 9
• MINIMIZE As opioid addiction has reached crisis proportions, Dr.
Sigman says surgeons in a variety of fields have worked to reduce the
need for opioids after procedures, in the hope that fewer patients
would become dependent on or addicted to pain pills.
Caitlin
Mahoney,
NP-C
