{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T01:31:13Z","timestamp":1777944673270,"version":"3.51.4"},"reference-count":38,"publisher":"SAGE Publications","issue":"1-2","license":[{"start":{"date-parts":[[2022,3,24]],"date-time":"2022-03-24T00:00:00Z","timestamp":1648080000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Perioperative Practice"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Currently, over half of drug overdose deaths are due to opioids. Opioid alternatives may be prescribed to help curb the opioid epidemic. However, little is known about their efficacy for acute postoperative pain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We studied patients who underwent low-risk outpatient surgery. Perioperatively, all patients were started on an anti-inflammatory bundle consisting of multimodal pain remedies. Opioids were available to the patients postoperatively. Pain scores and opioid use were recorded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Over 18 months, 120 patients underwent low-risk outpatient surgery and all used the anti-inflammatory bundle. All patients had a significant decrease in postoperative pain scores (p\u2009=\u20090.001). There was no significant difference in postoperative pain scores between those who followed the anti-inflammatory bundle alone and those who also used opioids (mean 2.2 vs 3.1\/10). Twenty-five (21%) patients were using opioids preoperatively and 50 (42%) postoperatively. Of those using opioids preoperatively, six (24%) patients used the anti-inflammatory bundle alone and avoided opioids postoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>For 58% of our patients, an anti-inflammatory bundle alone provided adequate pain control after a low-risk outpatient operation, such as hernia repair. Our practice uses the anti-inflammatory bundle for all patients. Our goal is to reduce both the need for opioids and the surgeon\u2019s contribution to the opioid epidemic.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17504589211031069","type":"journal-article","created":{"date-parts":[[2022,3,24]],"date-time":"2022-03-24T19:29:54Z","timestamp":1648150194000},"page":"30-36","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["An anti-inflammatory bundle may help avoid opioids for low-risk outpatient procedures"],"prefix":"10.1177","volume":"33","author":[{"given":"Rachel","family":"Dbeis","sequence":"first","affiliation":[{"name":"Department of Surgery, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khadij","family":"Assani","sequence":"additional","affiliation":[{"name":"Department of Medicine, Skagit Valley Hospital, Mount Vernon, WA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4772-5522","authenticated-orcid":false,"given":"Negin","family":"Fadaee","sequence":"additional","affiliation":[{"name":"Beverly Hills Hernia Center, Beverly Hills, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Desmond","family":"Huynh","sequence":"additional","affiliation":[{"name":"Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali","family":"Khader","sequence":"additional","affiliation":[{"name":"Department of Radiology, Beth Israel Lahey Health, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shirin","family":"Towfigh","sequence":"additional","affiliation":[{"name":"Beverly Hills Hernia Center, Beverly Hills, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2022,3,24]]},"reference":[{"key":"bibr1-17504589211031069","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-011-1793-z"},{"key":"bibr2-17504589211031069","unstructured":"American College of Surgeons Division of Education 2018 Safe and effective pain control after surgery Available at: https:\/\/www.facs.org\/-\/media\/files\/education\/patient-ed\/safe_pain_control_adult.ashx (Accessed 5 February 2020)"},{"key":"bibr3-17504589211031069","unstructured":"American College of Surgeons (ACS) 2017 Statement on the opioid abuse epidemic Available at: https:\/\/www.facs.org\/about-acs\/statements\/100-opioid-abuse (Accessed 5 February 2020)"},{"key":"bibr4-17504589211031069","unstructured":"American College of Surgeons (ACS) 2018 Opioid policy steering committee Available at: https:\/\/www.facs.org\/-\/media\/files\/advocacy\/federal\/fda_opioid_letter.ashx (Accessed 5 February 2020)"},{"key":"bibr5-17504589211031069","unstructured":"American Hospital Association (AHA) 2020 CDC: drug overdose deaths up 4.6% in 2019 Available at: https:\/\/www.aha.org\/news\/headline\/2020-07-16-cdc-drug-overdose-deaths-46-2019#:\u223c:text=Drug%20overdose%20deaths%20in%20the,by%20drug%20category%20and%20state (Accessed 2 December 2020)"},{"key":"bibr6-17504589211031069","unstructured":"Arnica Montana 12C Directions nd Arnicare Available at: https:\/\/www.arnicare.com\/about\/arnica-pellets\/arnica-montana-12c\/ (Accessed 9 March 2020)"},{"key":"bibr7-17504589211031069","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpsurg.2020.100794"},{"key":"bibr8-17504589211031069","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctim.2006.04.004"},{"key":"bibr9-17504589211031069","doi-asserted-by":"publisher","DOI":"10.1016\/j.clindermatol.2010.03.028"},{"key":"bibr10-17504589211031069","unstructured":"Centers for Disease Control and Prevention (CDC) 2020a Drug overdose deaths Available at: https:\/\/www.cdc.gov\/drugoverdose\/data\/statedeaths.html (Accessed 24 February 2020)"},{"key":"bibr11-17504589211031069","unstructured":"Centers for Disease Control and Prevention (CDC) 2020b Opioid overdose \u2013 understanding the epidemic Available at: https:\/\/www.cdc.gov\/drugoverdose\/epidemic\/index.html (Accessed 27 April 2020)"},{"key":"bibr12-17504589211031069","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000000312"},{"key":"bibr13-17504589211031069","unstructured":"Davenport S, Weaver A, Caverly M 2020\n                      Economic Impact of Non-Medical Opioid Use in the United States\n                      . 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