"We're trying to be total perioperative physicians, not just intraopera-
tive physicians," says anesthesiologist Zachary Turnbull, MD, the med-
ical director of performance improvement and the director of the
Center for Perioperative Outcomes at New York's Weill-Cornell Medical
College.
Experts are reassessing the hard-and-fast rule of fasting at midnight
the night before surgery. New thinking on NPO involves having
patients drink carbohydrate-rich supplements 2 to 3 hours before sur-
gery. The developing concept is a definite satisfier for patients, who
show up for surgery feeling comfortable and perhaps less anxious.
They're also hydrated and nourished, and a growing body of research
suggests patients who don't go NPO experience fewer post-op compli-
cations and recover faster.
"You want to consider what patients are doing at home," says Dr.
Turnbull. "They have better outcomes if they eat well and are well
hydrated, if they're exercising a little bit, if they're training for surgery
and doing the right things for their body to recover from an insult. That
lets us manage the intraoperative part in such a way that we maximize
the post-op period and patient outcomes."
2. Maximized multimodal regimens
To get at the root of post-op pain, you should attack it with a multi-
modal approach (using 2 or more different methods or medications to
manage pain) rather than using opioids alone, says Dr. Turnbull.
Acetaminophen, COX-2 inhibitors and gabapentinoids are among the
analgesics that address the "multitude of pathways" that can lead to
pain. But here, too, there's a balancing act.
"With Gabapentin and pregabalin, for example, there's definitely a
pain benefit, and they do reduce the need for opioids," says Dr.
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