fully structured multimodal regimen a virtual necessity if you want to
provide cutting-edge patient care that's heavy on pain relief but light on
opioids.
Beyond the buzzword
The phrase "multimodal pain management" has been thrown around
often in recent years, so it's easy to lose track of what it actually
means. From an outpatient perspective, a multimodal approach to
analgesia can be boiled down to attacking pain with a combination of
methods.
• Interventional techniques, including spinal anesthesia and ultra-
sound-guided peripheral nerve blocks are among the most effective
opioid-sparing analgesic tactics outpatient facilities have at their dis-
posal. "If there's an opportunity to do regional anesthesia for patients,
we're going to take it," says Curtis Choice, MD, MS, director of anes-
thesiology at Montefiore Hutch-inson Metro ASC in the Bronx, N.Y.
And why shouldn't they? The effectiveness of regional blocks has
grown exponentially thanks to advances in ultrasound guidance
technology. "Historic-ally, regional anesthesia was done almost
blindly with a nerve stimulator," says Dr. Choice. "But nowadays, we
can do a lot of these blocks safely and efficiently by going right at
the nerves where the generation and propagation of the pain
impulse occurs."
With ultrasound guidance, the precision and safety of block place-
ment are remarkable. Anesthesiologists can do everything from visu-
alizing the brachial plexus and seeing the needle sheath to gradually
giving a local anesthetic through hydrodissection. "You can see the
nerves and blood vessels, so you have less incidence of issues like
local anesthetic systemic toxicity," says Dr. Choice. "You have a
greater safety profile because of the technology."
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