Outpatient Surgery Magazine

Special Edition: Opioids - January 2020 - 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.

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night mandates helps to clear up the confusion. "It eliminates the vari- ables that can cause providers to wonder whether they're dealing with a pain issue or a failure to optimize fluid levels before surgery," says Dr. Luke. "Evidence shows drinking clear fluids before surgery pro- vides more benefit in terms of absorption into the body than intraop- erative administration of IV fluids and positively impacts the body's fluid volume status." 3. Attack pain from every angle Dr. Luke champions opioid-free anesthesia and strongly urges the use of regional anesthesia — he calls it the cornerstone of UPMC's perioperative pain management program — whenever it's deemed appropriate. Nerve blocks can function as the primary anesthetic absent any opi- oids, says Michael Kim, MD, medical director of the value improve- ment office and clinical assistant professor of anesthesiology at Keck School of Medicine. Anesthesia providers there routinely administer retrobulbar, superficial cervical plexus and sphenopalatine blocks for surgeries involving the head and neck. They rely on the "big 5" — interscalene, supraclavicular, femoral, popliteal and adductor canal nerve blocks — to provide analgesia for the majority of patients who undergo orthopedic procedures. As an adjunct to nerve blocks, the right multimodal cocktail is invaluable in curbing post-op opioid usage. "Each patient gets 1g of PO Tylenol to start," says Dr. Dickerson. "They also get celecoxib or intraoperative ketorolac, with or without gabapentinoids, which have been shown to reduce opioid requirements and aid in preventing chronic post-surgical pain. "We also employ a multimodal general anesthetic in the OR, which includes NMDA antagonists like magnesium and ketamine, and anti- 4 4 • 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

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