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Special Edition: Anesthesia - July 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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age the post-op pain of total knee patients and reduce their risk of long-term opioid dependence, but you don't need to totally eliminate the use of opioids to enhance recoveries. Focus on opioid-sparing techniques instead of trying to eliminate their use altogether, suggests Girish P. Joshi, MBBS, MD, FFARCSI, a professor of anesthesiology and pain management at the University of Texas Southwestern Medical Center in Dallas. "Studies have shown that the judicious use of intraoperative opioids can be beneficial to a multimodal pain management plan," he says. "The primary aim is to use less opioids than you used before." Accomplishing that goal requires your anesthesia team to target and block sensory nerves and administer non-opioid analgesic agents. Longer-lasting comfort Several years ago, providers learned to reduce pain after total knee arthroplasty for the initial 24 hours post-op through the use of peripheral nerve blocks, local infiltration analgesia and multimodal pain relief. "But when the blocks wore off, patients were uncomfortable, and often had sudden high requirements for opioids to treat breakthrough pain," says Dr. Soffin. Now, the goal is to find ways to take these techniques to the next level by extending the duration of pain relief without the use of opi- oids. "One solution has been to add an adjuvant, like steroids, to local anesthetics," says Dr. Soffin. "Extended duration formulations of local anesthetics are also increasingly being applied to total knee arthro- plasty, but their cost relative to outcome benefits remains to be fully established." She points out that cooled radiofrequency ablation techniques have emerged as a potential option to denervate sensory nerves supplying J U L Y 2 0 2 0 • O U T P A T I E N T S U R G E R Y . N E T • 1 3

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