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Patient Risk Rises with Local Anesthetics Shortage

By John Commins  
   April 19, 2018

Advocates urge clinicians to consult with elective surgery patients about local anesthetics shortages, the potential health risks, and alternative forms of pain management.

A global shortage of local anesthetics threatens patient care and could worsen the opioid crisis as patients and their caregivers use other methods of pain relief, the American Society of Regional Anesthesia and Pain Medicine says.

Because of that, ASRA is urging hospitals, physicians and other clinicians who provide elective surgery to consult with their patients ahead of the procedure to warn of potential local anesthesia shortages and their potential health risks, and to discuss alternative strategies for pain management.

"This conversation needs to be taken to the public," says Edward R. Mariano, MD, a professor of Anesthesiology, Perioperative and Pain Medicine Stanford University School of Medicine.

"If I were helping a family member make a decision about when and how to have a knee replacement surgery scheduled, I would want to know whether the hospital where my mom or dad was having knee replacement actually has suitable stock of local anesthetics so my family member is going to get good care," Mariano says.

Even minor surgical procedures can lead to long-term opioid use. Regional anesthesia, especially with continuous peripheral nerve block techniques, has been shown repeatedly to reduce patients’ need for opioid analgesia, Mariano says.

Now, this care is threatened with ongoing global shortage of local anesthetic drugs, including bupivacaine, lidocaine, ropivacaine. Targeted injections of these numbing drugs at the surgery site can eliminate the need for injectable opioids such as fentanyl, hydromorphone, morphine, which also are in short supply.

Mariano says elective surgery patients oten know the date of their procedure months in advance, which provides an excellent window of opportunity for clinicians to consult with them about pain management.

"From the patient point of view, when you show up for your surgery you don't necessarily know when you go in whether that hospital is suffering from a local anesthetic shortage," he says. "It is not a reason that most hospitals would consider for delaying or even cancelling elective procedures. But, we know from our data that certain types of anesthetics and pain control modalities have a direct positive effect on decreasing opioid use."

Mariano says patients must be fully informed about any potential health risks before elective surgery.

"For knee replacement patients, for example, there is an association between having a spinal or an epidural anesthetic and having a lower risk of 30-day mortality. That's huge," he says.

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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