Tackling Post-Surgical Pain Without Narcotics: Orthopedic Surgeon Brings New Protocol to Benefis Helena Specialty Center

Pain is a common concern when considering surgery. Likewise, pain control after surgery can also cause worry. Typically, post-surgical pain is controlled with narcotic pain medications — opioids like Percocet, hydrocodone, oxycodone, and others. Those medications carry concerns of their own.

Opioids have been at the center of a substance abuse crisis in the United States, with their use tied to addiction and chemical dependency issues, overdoses, and deaths.

Chase Dukes, MD, is a board-certified orthopedic surgeon at Benefis Helena Specialty Center and a proponent of a narcotic-free post-operative (post-op) protocol that allows his patients to recover without the use of narcotic-based pain medications. In fact, Dr. Dukes developed the protocol he uses now during his tenure in the U.S. Army in 2022.

His concerns about the potential repercussions of opioid use led Dr. Dukes to research and investigate the true need for narcotic pain medications following most orthopedic surgeries.

“The goal is to help people and make them better, not create additional problems for them,” he says. “I thought, ‘There has to be a better way.’”

Advances in orthopedic surgical techniques and the increased use of multimodal pain control — a comprehensive approach to managing post-op pain and inflammation that includes multiple intervention techniques such as non-narcotic pain medications, strategic therapeutic icing, and medications that reduce swelling after surgery and bleeding during surgery — led Dr. Dukes to prescribe fewer and fewer narcotic pain medications following certain surgical procedures like total joint replacements, rotator cuff repairs, and anterior cruciate ligament (ACL) surgery.

He notes that while narcotic medications have a role in the practice of medicine, they can cause issues such as nausea, constipation, itching, a reduced ability to breathe, sleep disturbances, and even delirium, especially in older adults. Discontinuing the use of narcotic medications after a procedure can even lead to an increased sensation of pain.

“Ultimately, these medications bind to the mu opioid receptors in your brain and throughout your body, which control the sensation of pain,” Dr. Dukes explains. “They don’t do anything to actually prevent the cause of pain … so the question became, ‘Does the utilization of narcotics do anything to affect patients’ overall pain trajectory?’ And the answer for most people is, ‘No.’”

Pain is a byproduct of inflammation, so the goal of Dr. Dukes’ protocol is to mitigate and treat inflammation, and that makes patients feel more comfortable and able to participate in physical therapy.

“You’ll have less swelling and inflammation, you’ll hurt less, and your early range of motion following surgery will probably be better,” he says.

That was the case for Jacob Reddick, a 44-year-old Helena man who had both of his hips replaced by Dr. Dukes.

“I’d never had any major surgery in my life before that,” he says. “I think the extent of my narcotic pain medication use was after I had my wisdom teeth removed.”

Jacob’s mobility had deteriorated to the point that he couldn’t run, carry things, or even bend over to tie his shoes. He knew he needed the surgeries, but he had heard negative things about surgery and the narcotic medications prescribed to control the pain afterward.

“But Dr. Dukes said I would be just fine, and he was right. I walked out of the surgery center the same day,” Jacob said. “I wasn’t in enough pain to need anything more than Tylenol.”

Jacob reported a significant reduction in the pain he had been experiencing before surgery, and that his quality of life was improving significantly just one week after his second surgery.

“I’m going to be able to move again.”

While some patients are nervous about using narcotic pain medications, the fear of breaking what amounts to a medical tradition can also make patients anxious.

Austen Sparrow is a physician assistant in orthopedics at Benefis Helena Specialty Center. She and Dr. Dukes have worked together since 2023. Austen works with patients before and after surgical procedures and also assists in the operating room.

“I’d say we get overwhelmingly positive feedback from patients, even those who were nervous going into surgery,” she says. “But they follow our protocol, and they come back at their first post-op visit and they are very grateful that we did not prescribe narcotics. They are very impressed with how they handled the recovery process without extra medication.”

Dr. Dukes and Austen estimate that more than 95% of their surgical patients successfully complete a narcotic-free post-op recovery. They engage in thorough and clear conversations with patients beforehand to set expectations.

“Surgery hurts, period,” Dr. Dukes says. “Three to five days after surgery, your pain is the worst because the inflammation and swelling peak during that time, but after you make it past that point, you become much more comfortable. That overall pattern doesn’t change whether you use narcotics or not.”

Dr. Dukes saw the potential of a “better way” for patients when he started developing his protocol years ago, and the proof came through satisfied patients and successful surgical outcomes.

“It changes your perspective on what’s possible with surgery,” he says, “and you feel good about providing a service to people that aligns with some of their values and assuages some of their fears and provides an overall large benefit to society.”