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Answering the Call - Outpatient Surgery Magazine - May 2020

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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suffer from chronic pain, have taken opioids for a long time or are on medication-assisted treatment programs," he says. "Time of surgery is very risky for them." If these patients' postoperative pain is not well-controlled, they could become addicted or relapse into addiction. Another trigger to employ this broader view is pro- cedures that cause a lot of pain, he says. In addition, not all pain is created equal. "There's nerve pain, vis- ceral pain, inflammatory pain, combination pain," says Dr. Dizdarevic. "You have these different pain pathways and different ways to decrease your pain by using different types of medication." Preoperative assessments of high-risk patients are crucial — prior history of pain, opioid use, past surgeries — can help deter- mine an optimal pain management path, says Dr. Dizdarevic. Then there's the procedure to consider. "Is it a simple surgery, complex surgery, intermediate surgery?" he says. "What index of pain does that surgery carry? What's the likelihood of this patient having severe pain after this surgery — or developing chronic pain?" Combining the unique patient and procedure factors, an appro- priate cocktail of analgesia can emerge. "For patients we don't think would be at particularly increased risk, we designed a basic multimodal analgesia protocol," says Dr. Dizdarevic. "If somebody is a higher risk, we go a step or two beyond and add extra measures. We look into multiple factors to come up with a plan that consists of some level of multimodal analgesia to begin. Then we develop a step or two or three beyond that depending on patient and surgery characteristics." OSM 6 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 • M A Y 2 0 2 0

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