inflammatories like lidocaine
and dexamethasone, all of
which have been shown to
reduce the amount of opioids
used to manage postopera-
tive pain," adds Dr.
Dickerson.
Surgeons sometimes hesi-
tate to have regional blocks
placed on their patients, says
Dr. Luke. "But that attitude is
changing," he adds, "because
of the data we've accumulated
over many years and the num-
ber of surgeries we've performed with regional that have slashed rates
of opioid dependence that can develop even after 4 or 5 days of use."
Multimodal pain medications — acetaminophen, NSAIDs, alpha-2
antagonists, gabapentinoids and ketamine are commonly used — keep
pain at bay when nerve blocks wear off. "Medications that were not
being used in the past are now being used routinely," says Dr. Luke.
4. Limit post-op prescriptions
The final stage of the care continuum is crucial. You want to send
patients home with a bare minimum of opioids and stress that the
medications should be used only as a last resort to treat break-
through pain.
"We're very cognizant of the risks associated with opioids and aware
of the importance of limiting post-op supplies," says Dr. Kim. "That's
why we give patients a script for 3 days' worth to help them manage
the initial wave of post-op pain and see them again before prescribing
J A N U A R Y 2 0 2 0 • O U T PA T I E N T S U R G E R Y. N E T • 4 5
• SWEET RELIEF With the right multimodal regimen, even the most
severe post-op pain can be managed with very few opioids.
Pamela
Bevelhymer,
RN,
BSN,
CNOR
