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Opioids block pain during surgery. One area doctor has another idea.

At the Medical Center of Trinity, Dr. Dilendra Weerasinghe pioneers an opioid-free anesthesia blend that shortens recovery times.
William Lemoine, right, attends a followup appointment with his surgeon, Dr. Dilendra Weerasinghe. Lemoine, 71 of Port Charlotte, recently underwent surgery using an opioid-free anesthesia protocol at the Medical Center of Trinity in New Port Richey. [LUIS SANTANA  |  Times]
William Lemoine, right, attends a followup appointment with his surgeon, Dr. Dilendra Weerasinghe. Lemoine, 71 of Port Charlotte, recently underwent surgery using an opioid-free anesthesia protocol at the Medical Center of Trinity in New Port Richey. [LUIS SANTANA | Times]
Published Oct. 7, 2019

TRINITY — William Lemoine woke up one day with a strange pain in his abdomen. In a few weeks, it was excruciating.

He went to a hospital in Port Charlotte, where he met Dr. Dilendra Weerasinghe. After performing an emergency surgery to fix a fold in Lemoine’s intestines, Weerasinghe (pronounced Wee-ra-sing-her) convinced him to come to the Medical Center of Trinity in Pasco County for a follow-up bariatric surgery that would end his pain for good.

“I followed him because I trusted him,” Lemione, 71, said of Weerasinghe. “So when he told me about doing the procedure a new way without any opioids, I said OK.”

Weerasinghe, who has worked for HCA hospitals in Florida for the last five years, developed a new blend of opioid-free anesthesia while working with a team in Port Charlotte. When he came to Trinity, he pressed to continue to use this method with his bariatric patients.

“William was the first patient to undergo the new anesthesia here at Trinity,” Weerasinghe said. “I trained in the (United Kingdom) where these methods are seen more often. So I know we can do better in this country.”

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Weerasinghe developed a protocol which uses magnesium sulfate, a salt often used as a laxative and to treat seizures; lidocaine, a drug commonly used to treat irregular heartbeats; and ketamine, a sedative and antidepressant — among other ingredients to keep patients pain-free for surgery. He also works with anesthesiologists to use nerve blocks in the area of the body affected by the surgery. This combination blocks the transmission of pain to the brain.

Weerasinghe said he’s found that patients recover in half the time without opioids, and that the risks are much lower for heavier patients, who are often the common candidates for bariatric procedures.

“Obese patients have high mortality rates in surgery because of complications from opioids,” Weerasinghe said.

Not everyone was convinced about Weerasinghe’s methods in the beginning. Dr. Johnathan Hisghman, an anesthesiologist, had read the preliminary research on using opioid-free drugs for anesthesia, but said he was skeptical.

“Opioid-free is a hot topic right now, but there’s not a lot of direction yet,” said Hisghman, who has worked in Trinity since 2006. “But I’ve seen firsthand how it works.”

Dr. John Hisghman, an anesthesiologist at the Medical Center of Trinity, administers an opioid-free anesthetic block prior to surgery. He was skeptical of the protocol at first, but says he later saw positive results. [HCA Healthcare]

The hardest part, he said, is convincing insurance providers that it’s a safe alternative. Opioids have been used as the standard of care in anesthesia since the 1960s.

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“If for some reason it isn’t working for a specific patient, we can still use opioids,” he said. “But the results we’ve seen are contradictory to modern anesthesia. I’ve never seen a patient stand up in the recovery room and tell us they feel no nausea before we tried this.”

Lemoine woke up from his major surgery and said he felt no pain. Weerasinghe also had him standing and walking within hours after the operation. He didn’t feel groggy like he had in past surgeries. And because there was less risk with no opioids in his system, he was allowed to eat and drink much earlier in recovery.

Weerasinghe admitted that opioids are still useful in some cases, and he does still prescribe them to some of his patients. But even then, he’s mindful of trying to prescribe the least amount possible. So far, Weerasinghe has performed surgery on three patients with this opioid-free method, and has two more scheduled in the coming weeks.

William Lemoine says he recovered much faster after a recent surgery using opioid-free anesthesia. [LUIS SANTANA | Times]

“This could be used for any surgery,” he said. “There’s a lot of enthusiasm for this idea in other parts of the world.”

HCA Healthcare, the corporate owner of the Medical Center of Trinity, tested Weerasinghe’s method as a pilot program and rolled out the protocol to more hospitals in the chain, said Dr. Larry Feinman, chief medical officer for HCA’s west Florida division. It’s based on a larger program called “Enhanced Recovery after Surgery,” developed by physicians in the U.K., to improve patient recovery by using less opioid medication.

“Some of these protocols are already in place in our emergency rooms to ease the number of opioids we’re prescribing,” Feinman said. “But we’re seeing significant reductions in hospital stays with what Dr. Weerasinghe is doing. If we can get you home quicker, you’re going to heal better."

The results from the pilot program so far have reduced overall opioid use in HCA hospitals by 50 percent, Feinman said. Readmission rates are down by 27 percent, he said.

Lemoine left the hospital just two days after his surgery, about half the average stay for that kind of operation.

“Given what you hear in the news about pharmaceutical companies, you can’t always trust them to have your interests at heart,” he said. “I see this as a better way.”

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