Improving Surgical Patient Outcomes and Minimizing Risks With Opioid-sparing Pain Control


Modules within this online curriculum aim to prepare the surgeon and surgical team in screening high-risk patients for opioid misuse, , utilizing intraoperative alternatives to opioids and algorithms for surgical pain management in opioid-dependent patients,best discharge practices, patient education, and system quality improvements and changes. A skills component is forthcoming and complements the online didactic portion (with the complete set of modules to be posted by October 2019); individuals, practice groups, or hospital systems are able to obtain credentialing upon successful completion of both components in their entirety.


It is estimated that 312 million operations occurred globally in 2012 (Weiser, Haynes, Molina, et al., 2016) with 60 million procedures performed in the United States (Hall & DeFrances, 2010; Cullen & Hall, 2009). Additionally, an average of 6.2 percent of surgical patients continue to use opioids for 3 months following their operation (Brummett, Waljee, Goesling, et al., 2017). This potentially equates to 18 million people each year using opioids subsequent to their recovery period.  
While there is an increased overall national awareness of the opioid epidemic with policy and education resources focused on professional training for chronic pain control, specific education for the surgical community—including professionals, patients, and families—are limited.

A 2017 American College of Surgeons (ACS) survey identified that:

  • 87 percent of responding surgeons’ patients experienced side effects from opioids when taken for the management of postoperative pain, yet 82 percent of surgeons did NOT have print or other materials they could use to help educate their patients on opioid use, abuse, and alternatives (Heneghan, Daly, Sachdeva, & Barot, 2018).   
  • Multimodal pain control was identified as effective and 90 percent of surgeons reported using local anesthetics as part of their pain control plan. 
  • Equally important, 52 percent of surgeons stated their patient population had used opioids in the past month prior to their operation, yet only 17 percent had any protocol for managing patients who were opioid dependent (Heneghan, Daly, Sachdeva, & Barot, 2018). 

In a 2018 course attended by 60 surgeon leaders responsible for implementing opioid-sparing system changes at their surgical facilities, 75 percent requested assistance from the ACS for further professional education on local anesthetic use for major surgical procedures (report summary given at ACS Clinical Congress 2018).   


This course includes training and reinforcement on best practices and standards for surgical pain control.


Course Outline

Best Practices for Opioid-Sparing Techniques Including Indications, Modifications, Complications and Safety Monitoring
Phillip Lirk, MD

Topics include:

  • Opioid-sparing Techniques
  • Local Anesthetics
  • Nerve Blocks
  • Wound Infiltration
  • Long-Acting Local Anesthetics

Target Audience

These courses can be taken by any member of the health care team or patient safety experts to support the didactic portion leading to the eventual credentialed training program on improving surgical patient outcomes and minimizing risks with opioid sparing pain control. Prime participants include: 

  • Surgeons
  • Nurses
  • Physician assistants
  • Home care providers
  • Nurse aids
  • Patient safety experts




Course summary
Course opens: 
Course expires: 

Patient Education Materials



  • Patient Pain Control Evaluation

Have your patients submit feedback regarding their pain control following their surgery.

Available at:

Disclosure Information

In accordance with the ACCME Accreditation Criteria, the American College of Surgeons must ensure that anyone in a position to control the content of the educational activity (planners and speakers/authors/discussants/moderators) has disclosed all relevant financial relationships with any commercial interest (see below for definitions). 

Commercial Interest:  The ACCME defines a “commercial interest” as any entity producing, marketing, re-selling, or distributing health care goods or services used on or consumed by patients. Providers of clinical services directly to patients are NOT included in this definition.
Financial Relationships: Relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit.  Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, speaking and teaching, membership on advisory committees or review panels, board membership, and other activities from which remuneration is received, or expected.  ACCME considers relationships of the person involved in the CME activity to include financial relationships of a spouse or partner.
Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect CME content about products or services of a commercial interest with which he/she has a financial relationship.

The ACCME also requires that ACS manage any reported conflict and eliminate the potential for bias during the educational activity.  Any conflicts noted below have been managed to our satisfaction. The disclosure information is intended to identify any commercial relationships and allow learners to form their own judgments. However, if you perceive a bias during the educational activity, please report it on the evaluation.

Faculty and Disclosures

Thomas A. Aloia, MD, FACS - Nothing to disclose
The University of Texas MD Anderson Cancer Center
Houston, TX

Chad Brummett, MD  - Nothing to disclose
The University of Michigan
Ann Arbor, MI 

John Daly, MD, FACS, FRCSI (Hon), FRCSG (Hon) - Nothing to disclose
Fox Chase Cancer Center, Temple Health
Philadelphia, PA

Michael J. Englesbe, MD, FACS - Nothing to disclose
University of Michigan
Ann Arbor, MI

Bridget Fahy, MD, FACS - Nothing to disclose
University of New Mexico
Albuquerque, NM

Jessica Lynn Gross, MD, FACS - Nothing to disclose
Wake Forest Baptist Health
Winston-Salem, NC

Kathleen Heneghan, PhD, RN - Nothing to disclose
American College of Surgeons
Chicago, IL

Lawrence Iteld, MD - Nothing to disclose
Iteld Plastic Surgery
Chicago, IL 

Phillip Lirk, MD - Nothing to disclose
Brigham and Women’s Hospital
Boston, MA

Lisa M. Mazzia, MD - Nothing to disclose
VA-National Center for Patient Safety
Ann Arbor, MI

Michael F. McGee, MD, FACS, FASCRS - Nothing to disclose
Northwestern Memorial Hospital
Chicago, IL 

Jonah Stulberg, MD, FACS - Nothing to disclose
Northwestern Memorial Hosptial
Chicago, IL 

James B Ray, PharmD, CPE - Nothing to disclose
University of Iowa 
Iowa City, Iowa

Michael Reinhorn, MD, MBA, FACS - Nothing to disclose
Boston Hernai and Pilonidal Center
Wellesley, MA

Scott Weiner, MD, MPH - Nothing to disclose
Brigham and Women’s Hospital
Boston, MA

A Certificate of Completion will be awarded for this course. 

This activity is not eligible for CME or CE credits.

Available Credit

Accreditation Period

Course opens: 
Course expires: 
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You may enroll in the online course at no charge. You will be asked to register for the course and provide information to complete the registration process. You will not be charged a participation fee.