Postoperative Opioid Addiction

It’s a Matter of Days

It can happen in a matter of days.1

We know that the overprescribing of opioids int he post-surgical setting has contributed to a major epidemic in the US. We also know you do what you can to reduce opioid prescriptions wherever possible.

But, did you know just how quickly opioid dependence can occur – within 3 DAYS of initial use?1


– ON-Q* is indicated to significantly reduce opioids and provide better pain relief than opioids alone.

– ON-Q* delivers continuous relief and non-opioid pain control for up to 5 days

– Limitations of some non-opioid therapies may actually result in increased opioid usage.6,7,11,27-28 LEARN WHY ->



1 Shah A, Hayes CJ, Martin BC. Characteristics of initial prescription episodes and likelihood of long-term opioid use – United States, 2006-2015. MMWR Morb Mortal Wkly Rep. 2017;66(10):265-269.

2 American Academy of Orthopedic Surgeons. Opioid use, misuse, and abuse in orthopaedic practice. Information Statement 1045. Published October 2015. Accessed February 2016.

3 The American Society of Interventional Pain Physicians (ASIPP) Fact Sheet. Overview on Prescription Drug Abuse. Accessed January 25, 2016.

4 Volkow ND, McLellan TA . Characteristics of opioid prescriptions in 2009. JAMA. 2011;305(13):1299‐1301.

5 Centers for Disease Control and Prevention. Opioid painkiller prescribing varies widely among states.‐opioid‐painkiller.html.

6 Benyamin R, Trescot AM, Datta S, et al. Opioid complications and side effects. Pain Physician. 2008;11:s105‐s120.

7 Bingham AE, Fu R, Horn JL, Abrahams MS. Continuous peripheral nerve block compared with single‐injection peripheral nerve block: a systematic review and metaanalysis of randomized controlled trials. Reg Anesth Pain Med. 2012;37(6):583‐594.

8 Forastiere E, Sofra M, Giannarelli D, Fabrizi L, Simone G. Effectiveness of continuous wound infusion of 0.5% ropivacaine by ON‐Q pain relief system for postoperative pain management after open nephrectomy. Br J Anaesth. 2008;101(6):841‐847.

9 Liu SS, Richman JM, Thirlby RC, Wu CL. Efficacy of continuous wound catheters delivering local anesthetic for postoperative analgesia: a quantitative and qualitative systematic review of randomized controlled trials. J Am Coll Surg. 2006;203(6):914‐932.

10 The Joint Commission. Safe use of opioids in hospitals. Sentinel Event Alert. Issue 49, August 8, 2012.

11 Aguirre J, Del Moral A, Cobo I, Borgeat A, Blumenthal S. The role of continuous peripheral nerve blocks. Anesthesiol Res Pract. 2012;2012:1‐20.

12 Chelly JE, Ghisi D, Fanelli A. Continuous peripheral nerve blocks in acute pain management. Br J Anaesth. 2010;105(suppl 1):86‐96.

13 Kessler RK, Shah M, Gruschkus SK, Raju A. Cost and Quality Implications of Opioid-Based Postsurgical Pain Control Using Administrative Claims Data from a Large Health System: Opioid-Related Adverse Events and Their Impact on Clinical and Economic Outcomes. Pharmacotherapy. 2013;33(4):383-391.

14 Dine A. Evidence based outcomes review. Continuing review and evaluation for I‐Flow Corporation. July 2012.

15 Jaeger P, Nielsen Z, Henningsen MH, Hilsted KL, Mathiesen O, Dahl JB. Adductor canal block versus femoral nerve block and quadriceps strength: a randomized, double‐blind, placebo‐controlled, crossover study in healthy volunteers. Anesthesiology. 2013;118(2):409‐415.

16 Mudumbai SC, Kim TE, Howard SK, et al. Continuous adductor canal blocks are superior to continuous femoral nerve blocks in promoting early ambulation after TKA. Clin Orthop Relat Res. 2014;472(5):1377‐1383.

17 Webb C, Mariano E. Best multimodal analgesic protocol for total knee arthroplasty. Pain Management. 2015;5(3):185‐196.

18 Kim DH, Lin Y, Goytizolo EA, et al. Adductor canal block versus femoral nerve block for total knee arthroplasty. A prospective, randomized, controlled trial. Anesthesiology. 2014;120(3):540‐550.

19 Bianconi M, Ferraro L, Traina GC, et al. Pharmacokinetics and efficacy of ropivacaine continuous wound instillation after joint replacement surgery. Br J Anaesth. 2003;91(6):830‐835.

20 Auyong DB, Allen CJ, Pahang JA, Clabeaux JJ, MacDonald KM, Hanson NA. Reduced length of hospitalization in primary total knee arthroplasty patients using an updated enhanced recovery after orthopedic surgery (ERAS) pathway. J Arthroplasty. 2015;30(10):1705‐1709.

21 Andersen HL, Gyrn J, Moller L, Christensen B, Dusanka Z. Continuous saphenous nerve block as supplement to single‐dose local infiltration analgesia for postoperative pain management after total knee arthroplasty. Reg Anesth Pain Med. 2013;38(2):106‐111.

22 Perlas A, Kirkham K, Billing R et al. The impact of analgesic modality on early ambulation following total knee arthroplasty. Reg Anesth Pain Med. 2013;38(4):334‐339.

23 Noviasky J, Pierce D, Whalen K, Guharoy R, Hildreth K. Bupivacaine Liposomal Versus Bupivacaine: Comparative Review. Hosp Pharm. 2014 Jun; 49(6): 539–543.

24 Golf M, Daniels SE, Onel E. A phase 3, randomized, placebo-controlled trial of DepoFoam® bupivacaine (extended-release bupivacaine local analgesic) in bunionectomy. Adv Ther. 2011;28(9):776-788.

25 Gorfine SR, Onel E, Patou G, Krivokapic ZV. Bupivacaine extended-release liposome injection for prolonged postsurgical analgesia in patients undergoing hemorrhoidectomy: a multicenter, randomized, double-blind, placebo-controlled trial. Dis Colon Rectum. 2011;54(12):1552-1559.

26 Ilfeld BM. Liposome bupivacaine in peripheral nerve blocks and epidural injections to manage postoperative pain. Expert Opin Pharmacother. 2013;14(17):2421-2431.

27 Abdallah FW, Halpern SH, Aoyama K, Brull R. Will the real benefits of single-shot interscalene block please stand up? A systematic review and meta-analysis. Anesth Analg. 2015;120(5):1114-1129.

28 Kean J, Wigderowitz CA, Coventry DM. Continuous interscalene infusion and single injection using levobupivacaine for analgesia after surgery of the shoulder: a double‐blind, randomized controlled trial. J Bone Joint Surg [Br]. 2006;88‐B:1173‐1177.

29 Parvizi J, Miller AG, Gandhi K. Multimodal pain management after total joint arthroplasty. J Bone Joint Surg Am. 2011 Jun 1;93(11):1075-84.

30 Webb C, Mariano E. Best multimodal analgesic protocol for total knee arthroplasty. Pain Management. 2015;5(3):185-196.

31 Dulaney-Cripe E, Hadaway S, Bauman R, Trame C, Smith C, Sillaman B, et al. A continuous infusion fascia iliaca compartment block in hip fracture patients: a pilot study. Journal of Clinical Medicine Research. 2012;4(1):45-8.

32 Foss NB, Kristensen BB, Bundgaard M, Bak M, Heiring C, Virkelyst C, et al. Fascia iliaca compartment blockade for acute pain control in hip fracture patients. Anesthesiology. 2007Apr;106(4):773-8.

33 Mouzopoulos G, Vasiliadis G, Lasanianos N, Nikolaras G, Morakis E, Kaminaris M. Fascia iliaca block prophylaxis for hip fracture patients at risk for delirium: a randomized placebo-controlled study. Journal of the American Geriatrics Society. 2001May;49(5):516-22.

34 Kinjo S, Lim E, Sands LP, Bozic KJ, Leung JM. Does using a femoral nerve block for total knee replacement decrease postoperative delirium? BMC Anesthesiology. 2012Mar10;12(4).

35 Del Rosario E, Esteve N, Sernandez MJ, Batet C, Aguilar JL. Does femoral nerve analgesia impact the development of postoperative delirium in the elderly? A retrospective investigation. Acute Pain. 2008Jun;10(2):59-64.

36 IFU – The ON-Q* Pain Relief System. Instructions for use.

37 Heller L, Kowalski AM, Wei C, Butler CE. Prospective, randomized, double-blind trial of local anesthetic infusion and intravenous narcotic patient-controlled anesthesia pump for pain management after free TRAM flap breast reconstruction. Plast Reconstr Surg. 2008;122(4):1010-1018.

38 Goyal N, McKenzie J, Sharkey PF, Parvizi J, Hozack WJ, Austin MS. The 2012 Chitranjan Ranawat award: intraarticular analgesia after TKA reduces pain: a randomized, double-blinded, placebo-controlled, prospective study. Clin Orthop Relat Res. 2013;471(1):64-75.

39 Beaussier M, El’Ayoubi H, Schiffer E, et al. Continuous preperitoneal infusion of ropivacaine provides effective analgesia and accelerates recovery after colorectal surgery. Anesthesiology. 2007;107(3):461-468.

40 Capdevila X, Barthelet Y, Ryckwaert Y, Rubenovitch J, d’Athis F. Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery. Anesthesiology. 1999;91(1):8-15.

41 Carli F, Clemente A, Asenjo JF, et al. Analgesia and functional outcome after total knee arthroplasty: periarticular infiltration vs continuous femoral nerve block. Br J Anaesth. 2010;105(2):185-195.

42 Dowling R, Thielmeier K, Ghaly A, Barber D, Boice T, Dine A. Improved pain control after cardiac surgery: results of a randomized, double-blind, clinical trial. J Thorac Cardiovasc Surg. 2003;126(5):1271-1278.

43 Ilfeld BM, Ball ST, Gearen PF, et al. Ambulatory continuous posterior lumbar plexus nerve blocks after hip arthroplasty: a dual-center, randomized, triple-masked, placebo controlled trial. Anesthesiology. 2008;109(3):491-501.

44 White PF, Rawal S, Latham P, Markowitz S, et al. Use of a continuous local anesthetic infusion for pain management after median sternotomy. Anesthesiology. 2003;99(4):918-923.

45 Haslam L, Lansdown A, Lee J, Vyver MVD. Survey of current practices: peripheral nerve block utilization by ED physicians for treatment of pain in the hip fracture patient population. Canadian Geriatrics Journal. 2013;16(1).16-21.

46 Zywiel MG, Hurley RT, Perruccio AV, Hancock-Howard RL, Coyte PC, Rampersaud YR. Health economic implications of periopoerative delirium in older patients after surgery for a fragility hip fracture. The Journal of Bone and Joint Surgery-American Volume. 2015May20;97(10):829-36.

47 Husain A, Lee GC. Establishing realistic patient expectations following total knee arthroplasty. J Am Acad Orthop Surg. 2015;23(12):707-713.

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