arduous journey, but I sense there is a paradigm shift occurring on the
management of post-operative pain with opioid alternatives."
Dr. Sigman points to a patient who's 12 days out from her total knee
replacement who hasn't required a single post-op narcotic pill. She
has full knee extension and 115 degrees of knee flexion, he says. And
she walked into Dr. Sigman's office for a post-op visit with a cane.
The woman had an Exparel (bupivacaine liposome injectable sus-
pension) field block at the time of surgery and an iovera cryotherapy
treatment 4 days before surgery. That's it? Pre-operative iovera
cryotherapy treatment followed by intraoperative Exparel? Yes, says
Dr. Sigman, that one-two punch gets almost all of his patients through
the "storm of pain" that closes in the first 72 hours after surgery.
Cryotherapy is the latest technique Dr. Sigman has incorporated into
his opioid-sparing knee surgery. iovera is a cryotherapy device — he
calls it his "Freeze Ray Gun" — that temporarily freezes the axons of
sensory nerves. The axons redevelop over 6 to 8 weeks after the stim-
ulus of pain from surgery has resolved, says Dr. Sigman, who per-
forms cryotherapy at his surgery center a few days before surgery fol-
lowed by an Exparel field block at the time of surgery.
Exparel gives excellent initial pain relief followed by long-term pain
relief from iovera, he says.
"We use saws and drills on a patient and it hurts like heck, but if you
can get them to a softer landing through that first 3 days afterwards,"
he says, "the pain is not as bad as it was when it first happened
because all of the chemicals that create that pain stimulus are washed
out of the system."
Here are a few more opioid-sparing strategies you should consider:
Regional anesthesia
8 0 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • O C T O B E R 2 0 1 8
