by Marissa Lorenz
Grand County’s Middle Park Health (MPH) is leading the way for Opioid-Free Anesthesia (OFA) and is the only hospital in Colorado to exclusively provide OFA to all surgery patients.
MPH’s Katie Hornbaker, CRNA and the only anesthesia provider in Grand County, has been exploring and building expertise in the use of opioid-free anesthesia since 2015, bringing best practice to MPH and the greater community.
“Other Colorado facilities may offer this service as an option,” Hornbaker explains, “but after numerous searches, I cannot find one facility in Colorado that is publicly promoting OFA. Intermountain Health Care in Utah promoted ‘first ever opioid free surgery program’ in February 2020. –I gave my last opioid in January 2017.”
The Society for Opioid Free Anesthesia describes OFA as “a safer option for anesthesia administration that maximizes a patient’s respiratory ability and aggressively treats their pain, while eliminating the unwanted side effects of opioids.”
“Traditional anesthesia typically includes opioids that block one pain receptor, and in turn, by blocking that receptor, also causes multiple negative side effects. These side effects include, but are not limited to: dysphoria, hyperalgesia, nausea, vomiting, respiratory depression, constipation, itching, and dependance,” explains Hornbaker.
Opioid addiction and overdoses have been increasing in the last 20 years, with over 232,000 opioid-related fatal overdoses between 1999 and 2018, according to the Centers for Disease Control. Much addiction is thought to begin with legitimate medical use of opioid-based pain relievers that develops into abuse of both prescription and illicit opioid drugs.
On top of reduced addiction risk, opioid-free anesthesia “is just one of the many ways to provide a safe anesthetic, but with many benefits,” details Hornbaker.
“OFA utilizes a multi-modal approach which blocks multiple pain pathways without the negative side effects. Not only does this approach reduce undesired side effects of opioids it has many desired benefits. Benefits include: better pain control, shortened recovery times, decreased hospital and patient costs, reduced postoperative complications, decreased risk for chronic pain following hernia repair, probable breast cancer recurrence rate, and decreased risk of metastasis following a cancer resection surgery.”
MPH’s Hornbaker anchors hospital’s expertise
Out of around 100,000 anesthesia professionals in the United States, only a few hundred provide opioid-free anesthesia, and only a few percent of those use it exclusively. But Hornbaker says that the path to promoting opioid-free anesthesia was a “no-brainer.”
“Being in the medical field, one commits to being a lifelong learner, and when research was proving that anesthesia could be safely performed without opioids and better outcomes, I wanted the patients of Grand County to have access to the highly specialized service. We are in the middle of an opioid epidemic and Middle Park Health has put many programs in place to reduce the amount of opioids prescribed and administered.”
Hornbaker is now a member of the Society of Opioid Free Anesthesia and attends annual conferences. She notes that additional training to perform OFA is independent learning. “No two nurse anesthesiologists provide OFA the same way. Those that are currently administering OFA have developed their own techniques. Due to my expertise I have been asked to speak and instruct at multiple conferences and events.”
But she emphasizes that administration of OFA “does not fall solely on the nurse anesthesiologist but takes a collaborative effort from the preoperative nurse, the surgeon, the circulator nurse, and recovery nurse. Opioid-free anesthesia is not effective without the effort of all the staff. MPH has such a dynamic motivated team and we are beyond grateful to be able to provide this highly specialized service to Grand County.”
OFA offers unique draw for hospital
Hornbaker indicates that the change from traditional to opioid-free anesthesia has been “very well-received by patients, staff, and surgeons. (…) Patients are discharged home with better pain control, and some have no pain at all.”
She indicates that patients are already coming to MPH from surrounding areas for the benefits of the OFA practice and that one patient traveled from as far as Texas to receive follow-up surgery with OFA.
The response seems to justify the program and the enthusiasm behind it. And Hornbaker hopes to see OFA become the norm in all surgeries. “In the near future,” she says, “opioid-free anesthesia will hopefully just be called “anesthesia.”