Jonathan L Halbach, DO, Paul Lewis, DO, Jason Brill, MD, James Wallace, MD, Ashley Zander, DO, Mike VanGent, DO, Kyle Gadbois, MD. Naval Medical Center San Diego
Objective: The prescribing of narcotic pain medication during humanitarian medical missions presents an ethical dilemma with the potential for adverse events without reliable follow-up. Some countries prohibit the distribution of narcotics presenting a challenge in the post-operative setting. We reviewed our experience with peri-operative multimodal pain control strategies during the 2016 Pacific Partnership mission.
Methods: We examined all general surgery cases performed during the 2016 Pacific Partnership, mission Timor Leste and Philippines, onboard the USNS Mercy performed by three attending and two resident surgeons. We included both laparoscopic and open procedures, and excluded all emergent operations. Post-operative pain control strategies were retrospectively reviewed for these cases.
Results: 40 routine general surgery cases performed in two countries met inclusion criteria and included: laparoscopic cholecystectomy (12); laparoscopic inguinal hernia (5); open inguinal hernia (7); lipoma or soft tissue mass excision (14); umbilical hernia repair (1); hemorrhoidectomy (1). All patients had local anesthetic administered at the wound sites at the time of operation. All patients received oral acetaminophen, and those who were deemed low risk of bleeding were prescribed oral ibuprofen during the post-operative setting. No patient was prescribed a PRN narcotic pain medication in the post-operative setting. No patient required a dose of narcotic pain medication after leaving the Post Anesthesia Care Unit. No patient was discharged with narcotic pain medication.
Conclusions: Multimodal pain control strategies offer an alternative to narcotic pain medications in the humanitarian setting. Our success with narcotic free pain control may reflect a difference between host nation populations and our domestic population. With increasing rates of prescription narcotic dependence in the United States, our experience with omitting narcotics from post-operative medications on Pacific Partnership 2016 may offer insight into the management of postoperative pain. Our success with narcotic free pain control calls into question the routine use of narcotics for ambulatory procedures in our domestic practice and suggests a potential area for future study.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87973
Program Number: MSS22
Presentation Session: Full-Day Military Surgical Symposium – General Surgery Presentations
Presentation Type: MSSPodium