Dr. Scott Sigman is a leader in opioid sparing orthopaedic surgery and has championed opioid-free surgery for many years.
After seeing the effects of the opioid crisis in his own community and across the country, Dr. Sigman has made it his mission to offer better options to patients that can effectively control post-operative pain without the need for highly addictive medications.
Why is it important to avoid opioid use whenever possible?
The highly addictive nature of opioids makes it a less than ideal option for pain control. Statistics suggest that even a short course of opioids can result in addiction, and that it is important to get patients off opioids as soon as possible to reduce the risk of long-term addiction:
- If a physician writes a prescription for opioids for a 24-hour period, 6 out of 100 patients will still be on opioids at one year.
- For a 10-day course of opioids, 13 out of 100 patients will still be on opioids at one year.
- For a 30-day prescription, one-third of patients are still on opioids at one year.
Pain control is necessary after surgery to allow patients to participate in physical therapy and rehabilitative exercises, but opioids are too risky to use throughout the recovery period. Fortunately, several non-opioid pain control methods have been developed that are very effective at controlling pain.
See Dr. Sigman’s TEDx Talk, “Changing the Paradigm of Pain Management”
How can post-surgery pain be managed without opioids?
There is a growing list of options for managing pain after orthopaedic surgery without the use of opioids, including:
- Over-the-counter pain medications like acetaminophen (Tylenol) and ibuprofen (Motrin & Advil)
- Ice therapy
- A bupivacaine liposome injectable suspension like EXPAREL
- A long-acting nerve block like iovera°
- A long-acting anesthetic like ZYNRELEF
- Laser therapy, like the treatments offered at OrthoLazer
Often, Dr. Sigman will recommend a combination of different non-opioid therapies to help control pain after orthopaedic surgery.
How does EXPAREL help with pain management?
EXPAREL is a single injection that is administered in the area where the surgery is being performed, during the procedure. It is a non-opioid, non-addictive medication. EXPAREL contains specially formulated bupivacaine (a type of local anesthetic) that is designed to provide long-lasting pain relief by slowly releasing the medication.
Most patients who have had EXPAREL have experienced pain relief for the first few days after surgery–often the most painful period. Clinical trials have shown that patients who received EXPAREL during their surgery went longer before needing opioids after surgery, and required fewer opioids than those who did not receive the injection.
Medications like EXPAREL can be very helpful in the recovery period after orthopaedic surgery, particularly for procedures that can have a painful recovery like total knee replacement. Effective pain control allows patients to begin moving and participate in physical therapy sooner, which is very beneficial after surgery. Additionally, clinical studies found that 10% of patients who had knee replacement surgery did not take opioids at all.
How does iovera° help with pain management?
iovera° is a long-lasting nerve block that works by applying freezing cold to peripheral nerve tissue. This temporarily stops the nerves from receiving pain signals.
During an iovera° treatment, Dr. Sigman applies a numbing agent to the treatment area to minimize discomfort. A small probe is then inserted into the skin, which creates a cold zone and temporarily freezes the nerve. This process is repeated until the targeted nerves are blocked. Because the procedure is highly targeted, it does not damage surrounding tissue.
The pain-relief effects of iovera° begin immediately and last up to 90 days after surgery. It is quite effective at relieving post-surgery pain, particularly for procedures like knee replacement. Studies have shown that with iovera°, 45% of patients needed less opioids within 12 weeks of knee replacement surgery, and 68% consumed less opioids during their hospital stay compared to knee replacement patients who did not receive iovera°.
How does ZYNRELEF help with pain management?
ZYNRELEF is an extended-release dual-acting local anesthetic that combines bupivacaine, a local anesthetic, with a low dose of meloxicam, a nonsteroidal anti-inflammatory drug. Dr. Sigman uses ZYNRELEF as a long-acting anesthetic for total knee replacement.
ZYNRELEF has a needle-free application method. It is a viscous solution that is applied directly to the affected tissue in the surgical site, after Dr. Sigman has completed final irrigation and suction, and prior to suturing. The medication stays where it is placed because it becomes more viscous when it comes in contact with moisture.
Patients who are given ZYNRELEF during a total knee replacement typically experience up to 72 hours of pain relief—the most painful period after a knee replacement. A study found that 39% of total knee replacement patients treated with ZYNRELEF and a non-opioid multimodal pain management regimen received no opioid discharge prescription and had no callbacks through day 11 of recovery.
How does OrthoLazer help with pain management?
OrthoLazer Centers utilize the MLS M8 Robotic Therapy Laser, the most powerful robotic laser in the world. It uses specific wavelengths of light to treat several painful and debilitating conditions.
With laser therapy, light energy enters the damaged cells and stimulates intracellular activity. This reduces pain in the area and speeds recovery of the damaged cells. Once the cells recover, the healing process is complete.
Laser therapy is FDA cleared, drug-free, and noninvasive. Its effects have been proven through extensive research. Benefits include:
- Rapid pain relief
- Strong anti-inflammatory effect
- Accelerated injury repair
- Quicker healing of wounds and post-surgical incisions
About Dr. Scott Sigman’s Mission with Opioid Sparing Surgery
Dr. Scott Sigman has been at the forefront of incorporating opioid sparing techniques and treatments into orthopaedic surgery. Recognizing the highly addictive nature of opioid medications, he is committed to providing alternatives to patients that are effective and non-addictive.
Dr. Sigman is the founder and Chief Medical Officer of OrthoLazer, the premier provider of non-invasive, pain-free, and drug-free laser therapy treatments. He is also a consultant for Pacira Pharmaceuticals, Inc., and has partnered with them on an initiative to use opioid alternatives in the surgical setting. He also frequently speaks about the topic in the news and publications, at national meetings, and on his own podcast, The Ortho Show.
Schedule a Consultation for Opioid Sparing Surgery in North Chelmsford, MA
If you would like to learn more about opioid sparing options for orthopaedic surgery, please contact our office at (978) 454-0706 to schedule a consultation with Dr. Sigman.