Outpatient Surgery Magazine

Her Loss, Their Gain - October 2019 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

Issue link: http://magazine.outpatientsurgery.net/i/1174852

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Page 80 of 126

O C T O B E R 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 8 1 by 50 mg of IV ketamine given 2 to 5 minutes before the incision and then a pre-incision subcutaneous injection of lidocaine with epinephrine, which Dr. Friedberg says acts faster than bupivacaine. The incremental propofol induction and maintenance protects against ketamine's negative side effects. The timing of the ketamine dose is key because failure to preemp- tively saturate the NMDA receptors causes the wind-up phenome- non, which eliminates the effectiveness of your opioid-free efforts to control post-op pain. Dr. Friedberg says giving the low dosage of ketamine in that 2- to 5-minute window doesn't merely "block" or close the door on the NMDA receptors, it slams that door shut. That's how patients wake up pain free. If you're skeptical about Dr. Friedberg's method, he urges you to try one part of his analgesic cocktail. "Administer 50 mg of keta- mine 3 minutes before the incision," he says, "and you'll see a dra- matic improvement in your patients' post-op [pain levels]." OSM patients once they return home, often mere hours after surgery, you have to make sure they know exactly how to manage pain on their own. In addition to strategic pain management instructions (go around the clock with your NSAIDS to stay ahead of the pain, for example), the EMR at Montefiore Hutchinson Metro ASC is set to flag any patient who gets a nerve block, so they receive additional discharge instructions. "The directions cover everything patients might encounter," says Curtis Choice, MD, MS, Montefiore's director of anesthesi- ology. "It lets patients know things like when their block will wear off, say, at 2 a.m., and tells them not to be alarmed if they wake up in the morning with their arm still numb." —Jared Bilski

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