identified as a prob-
lem, we had to offer a
solution."
Attacking surgical
pain with a combina-
tion of local anesthet-
ics and non-opioid medications is that solution, and has taken on
greater importance in light of the opioid epidemic. Population-based
studies involving hundreds of thousands of patients have backed the
clinical benefits of multimodal pain management and shown how it
impacts opioid consumption in the real world.
"We assumed it made a difference before we had the data — it made
logical sense that using a combination of methods to manage post-op
pain would reduce the need for opioids," says Dr. Memtsoudis. "We've
been able to put data behind those assumptions, and show on a big
level that it's true."
Targeted infusions
Numbing nerves around the surgical site is an essential aspect of any
multimodal anesthesia regimen. Neuraxial anesthesia and peripheral
nerve blocks provide superior pain relief when compared with opioid-
based strategies for patients undergoing extremity surgeries or abdomi-
nal procedures, says Eric Schwenk, MD, FASA, director of orthopedic
anesthesia at Sidney Kimmel Medical College at Thomas Jefferson
University in Philadelphia, Pa., who adds that placing drug-infusing
catheters at the surgical site extends the pain-relieving effects of region-
al blocks.
Dr. Schwenk oversees the multimodal anesthesia program for
Jefferson's orthopedics service line, a specialty with complex proce-
dures that often leave patients in severe pain. He says knee replace-
1 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J A N U A R Y 2 0 2 0
Opioids were never intended to be
used as the cornerstone of post-op
pain management practices.
— Eric Schwenk, MD, FASA