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• W2464151865 abstract "FigureAn emergency department in Paterson, NJ, has started using laughing gas to battle the opioid epidemic. “What we were doing before didn't have the best results, so [we thought] let's try a different way besides pills. I know they're easy to take, but they have risks,” Alexis LaPietra, MD, the medical director of pain management at St. Joseph's Regional Medical Center's emergency department, told National Public Radio (NPR). Instead of giving IV opioids, EPs are giving patients a combination of ketamine and nitrous oxide. To relieve fractures, for example, the hospital's ED uses ultrasound to find nerves that can be injected with a numbing agent to block the pain. Seventy-five percent of the 300 patients treated during the first two months of St. Joseph's program left the ED without needing opioids, according to Mark Rosenberg, MD, the ED's chairman. Using laughing gas is part of a larger initiative developed and implemented at St. Joseph's, Alternatives to Opiates Program (ALTOSM). Launched in early January, ALTOSM is an alternative approach to acute pain management without using opioids to avoid potential addictions associated with opioid use. The program uses targeted nonopioid medications, trigger-point injections, nitrous oxide, and ultrasound-guided nerve blocks to tailor its patients' pain management needs and avoid opioids whenever possible, for example, in cases of kidney stones, acute low back pain, broken bones, acute headache, and migraine pain. “The point here is not to be for or against opioids any more than it makes sense to be for or against antibiotics,” John Markman, MD, a neurologist at the University of Rochester who specializes in pain management, told NPR. “The goal is to learn to use them skillfully to minimize the public health risks because [those] are significant. We are not opioid free. Even though it's alternatives first, we will use whatever pain medication we need to improve the care of the patient.” Research on opioid prescribing published in the September 2015 issue of Annals of Emergency Medicine found that the median number of pills per prescription in the emergency department is 15, and the vast majority — more than 99 percent — were immediate-release formulations. “We also discovered that less than two percent of prescriptions were for more than 30 tablets, and those were for diagnoses like long bone fractures and cancer,” said Scott Weiner, MD, an author of the study and the assistant director for ED operations at Brigham and Women's Hospital in Boston. (Ann Emerg Med 2015;66[3]:253.) More Pain Treatments Watch a video and read a post on trigger point therapy by Larry Mellick, MD, at http://emn.online/MellickJan13. Read another blog post by Dr. Mellick on oral nerve blocks at http://emn.online/MellickDec14. “Ultrasound-Guided Suprascapular Nerve Blocks for Shoulder Dislocations” by Christine Butts, MD, is available at http://emn.online/SoundSept14. Read another article by Dr. Butts on locating the median and ulnar nerves with ultrasound at http://emn.online/SoundNov14. Martha Roberts, ACNP, CEN, and James R. Roberts, MD, review head and neck blocks in their blog, Procedural Pause, at http://emn.online/PauseSept14. Read the article, “Staying Hip with the Hip Block,” by Graham Walker, MD, at http://emn.online/EmergentologyApr15." @default.
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