Thomas Baribeault, DNP, CRNA practices at Southern Regional Medical Center in Atlanta, Georgia where he is the clinical coordinator for nurse anesthesia residents doing general OR and obstetric rotations. He is also the founder of the Society for Opioid-Free Anesthesia (SOFA). SOFA is a non-profit organization dedicated to education and research on opioid-free anesthesia and post-operative pain management. He lectures nationwide on obstetric anesthesia, acute surgical pain management, non-surgical pain management and point-of-care ultrasound. He earned a bachelor’s degree in nursing from The Ohio State University, a master’s of science in nursing and anesthesia residency from Case Western Reserve University and a doctorate in nursing practice and pain management fellowship from the University of South Florida.
Q: What sparked your interest in the concept of delivering anesthesia in innovative ways that limit or restrict the use of opioids?
A: For me, it was never about eliminating an entire class of medications, but learning how to give a safer anesthetic with fewer side effects than what is possible with a traditional opioid-inclusive anesthetic. When the idea of including opioids into anesthetics became popular in the 1960s, it improved the quality of anesthesia being given and made it safer. Fifty years later, we have learned that opioids have more side effects than nearly any other class of medication AND, more importantly, we have better options. We have newer drugs that are far safer and cause fewer side effects, we have learned to use older medications in better ways and regional anesthesia has progressed to the point where we can numb parts of the body that were not options before. Opioids are no longer necessary to give a quality anesthetic, and the instances where they are beneficial have decreased exponentially.
Q: We know how beneficial it can be for patients to receive opioid-free anesthesia. How can opioid-sparing initiatives benefit hospitals and surgery centers?
A: Numerous studies have shown that not only is opioid-free anesthesia good for patients, it is also good for facilities. Reducing complications such as post-operative pain, nausea and vomiting, and respiratory depression leads to fewer unexpected admissions after surgery and patients being able to go home sooner after surgery. This leads to reduced morbidity and mortality, reduced costs and increased patient satisfaction.
Q: How do you encourage other anesthesia providers who are hesitant to learn how to perform opioid-sparing anesthetic techniques?
A: It is always difficult and often scary to start something new, especially in the world of anesthesia where we are constantly making high risk decisions; however, we try to make it as easy as possible for providers to start giving opioid-free anesthesia in several ways. One is to have an easy-to-follow protocol in place for providers that lays out what to do and breaks it down into easy to follow steps. This way, providers can be assured that they are doing things correctly and will have good outcomes. We also strive to find surgeries and patient populations where opioid-free anesthesia will have the biggest impact and promote its use. It is expected that in surgeries like bariatrics, breast and spine that opioid-free anesthesia will be utilized and everyone from the surgeon to the anesthesia techs are expecting it. This way, anesthesia providers who are unfamiliar with giving opioid-free anesthesia are not expected to make the decision to give opioid-free anesthesia when they lack confidence in the technique or are unaware of the benefits.
Q: What are the most common barriers to a facility’s success in launching an opioid-sparing initiative, and how can these barriers be overcome?
A: The answer is always education and looking for those opportunities where you can show how opioid-free anesthesia can reduce complications and costs. Being a relatively new technique that is often misunderstood, the barriers are all due to people not understanding what it is and how dramatically it increases patient outcomes. A few common examples of these barriers: pharmacy not granting access to necessary medications, nurses and surgeons not working together to make sure patients get nerve blocks prior to surgery or anesthesia providers not wanting to take the time to administer an opioid-free anesthetic.
Q: In your current role with DPI Anesthesia, can you provide an example of how your efforts to reduce opioid usage supported achieving a client facility’s goals?
A: In Atlanta, we have a bariatric surgeon who was unhappy with the amount of postoperative pain, nausea and vomiting her patients were experiencing. This was leading to longer stays in the hospital, poor patient satisfaction and putting her patients at risk for rupturing the suture lines she was placing in the stomach. We instituted a protocol for her patients that included opioid-free anesthesia as well as multimodal analgesia and were able to almost eliminate the rates of post-operative nausea and vomiting while concurrently dramatically reducing the amount of postoperative pain.
Are you interested in implementing opioid-sparing strategies at your facility? Contact us today at 800.454.9902 to learn more.