Two new programs at Southwestern Vermont Medical Center (SVMC) are decreasing the need to prescribe opioids to patients receiving obstetrical and gynecologic care. Nitrous oxide is now available as an alternative to opioids for pain management during childbirth. In addition, fewer opioids are needed among hysterectomy patients as a result of the introduction of a new enhanced recovery program for the procedure.
"Like all medical providers, we are looking for ways to maintain quality care and manage pain for patients while decreasing the use of opioids,” said Malcolm Paine, MD, chair of OB/GYN at SVMC. “We are really proud of both of these programs for accomplishing these aims."
In the past, patients who needed pain relief during childbirth may have received morphine or other opioids. Nitrous oxide can be used early in labor, at the same point as morphine, as an alternative method to relieve pain. A mixture of half nitrous oxide and half oxygen is inhaled. It is not addictive and works to treat labor pain.
Introducing the availability of nitrous oxide involved purchasing equipment and conducting trainings with the care team, including nurses, physicians and midwives. A special badge alert system is used to monitor that any exhaled gas is within safety limits.
"We are really excited to offer this as an alternative for pain management,” said Deborah Mone, RN, a nurse on the Women’s and Children’s Unit at SVMC. “It is beneficial for many patients who would like pain management during labor."
The Enhanced Recovery Program for Hysterectomy Patients, also known as the Fast Track Hysterectomy, similarly improves care for all patients while decreasing opioid exposure. Formerly, hysterectomy patients would have received the procedure and were often sent home with an opioid prescription to manage pain. Under the new protocol, they follow a very specific preparation and recovery plan that decreases complications and pain after the surgery.
The plan includes nutritional and exercise recommendations in addition to an emphasis on lung function. Many patients return home the same day and are able to manage pain with over-the-counter medications, rather than opioids.
Both programs are endorsed by the American College of Obstetricians and Gynecologists. While some regional hospitals offer programs similar to one or both of SVMC’s nitrous oxide or Fast Track Hysterectomy programs, neither is widely available.
"Preparing the entire care team for important changes like these is not easy, but it is important,” Paine said. “Doing this work allows us to improve care for all and decrease the effects of opioids on our patients and communities."