This Nashville School Wants To Take Opioids Out Of The Operating Room | Nashville Public Radio

This Nashville School Wants To Take Opioids Out Of The Operating Room

Sep 26, 2016

Chris Hulin, who is president of the Middle Tennessee School of Anesthesia, just had a golden opportunity to play the patient.

"I recently had surgery on my left foot," he says, apologizing for wearing Birkenstocks around MTSA's Madison campus.

According to the school's internal figures, it trains more than two-thirds of the nurse anesthetists practicing in Middle Tennessee, and the institution is putting new emphasis on nerve blocks. So when Hulin went in for his foot surgery, he had the anesthesia team numb a particular nerve that deadened his whole leg instead of knocking him out. That meant he was wide awake.

"I said 'hi' to the surgeon a couple of times during the case. We conversed. Felt zero pain," Hulin says. "Didn't have any sensation in my foot for 24 hours."

Instead of potentially addictive narcotics, ibuprofen took care of the post-op pain. This is where the school sees opportunity to make some headway on the state's well-documented pain pill epidemic.

"We want to eliminate or potentially decrease the probability that the patient is going to be exposed the those opiates for the very first time," says Patrick Moss, who teaches acute pain management at MTSA.

More often than the opiates given during surgery, Moss says it's the pain pill prescriptions taken home that can lead to dependence or even addiction.

"We want to do everything we can to make that patient happy," he says. "And I think sometimes that's been unfortunately the inadvertent withholding of therapies such as what we're teaching here at our institution."

Kyle Benge, a student at Middle Tennessee School of Anesthesia, uses an ultrasound probe to pinpoint a nerve that might be blocked for a shoulder surgery.
Credit Blake Farmer / WPLN

What Is A Nerve Block?

Kyle Benge squeezes goop on his portable ultrasound device and slips it down the neck of a fellow student.

"So for this block here, we're looking at the shoulder and upper arm," he says while looking at a monitor the size of an iPad.

Benge pinpoints the relevant nerve. After numbing it up with a needle, a patient would be ready to go under the knife.

Nerve blocks have been around for decades. An epidural is probably the most common. But improvements in imaging technology are what has opened the door to wider application.

Still, nerve blocks haven't caught on widely. These techniques are kind of foreign to older practitioners. In fact, MTSA has had some trouble finding operating rooms where students can practice their nerve blocks.

“Adoption of that may be limited depending on the specialists you have in your hospital," says anesthesiologist David Edwards at Vanderbilt Medical Center.

Edwards is a nerve block believer, but he understands the hesitancy. They can sound intimidating to patients. And the procedures need more monitoring, which takes a larger team. The block could need to be redone mid-surgery. "What if it isn't completely helping the pain? What's your backup plan?" he asks.

But Edwards says nerve blocks need to be more widely adopted in an era when pain pills have become such a societal problem.

"If you're looking to reduce opioids in the hospital, and the procedure is amenable to a regional anesthetic such as a nerve block, then it seems pretty obvious," he says. "That's the choice that should be made."