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the protocol's opioid-sparing nature, patients are told they won't be totally pain-free after surgery. "We set those expectations before patients undergo surgery," explains Ms. Ahsanov. One piece of education that's as important involves the immediate postoperative period in the PACU. "During surgery, a tourniquet is applied to a patient's limb to reduce blood flow at the operative site," says Ms. Ahsanov. "When the tourniquet is removed, the limb reperfuses with blood. It causes a throbbing sensation, which can mimic a pain cri- sis. We discuss that with patients, telling them they're going to experience pain related to tourni- quet use and that we'll manage it." MEETH's anesthesiologists are now able to use less narcotics both intraoperatively and postopera- tively, and patients are ready for discharge sooner. OR turnover times have also improved. The new pain control protocols are popular among the center's clinicians. "Surgeons universally love the program — the improved efficiencies are key for them," says Dr. Alfano. "We found we can sometimes save an hour of OR time. From the anes- thesiologist's point of view, they like that the patients have a working block, and that there's no guesswork involved." OSM S E P T E M B E R 2 0 2 0 • O U T P A T I E N T S U R G E R Y . N E T • 3 7 HONORABLE MENTION No PENGs of Regret for These Patients Kimbrough Ambulatory Care Center in Fort Meade, Md., is a small military outpatient surgery center whose four ORs handle orthopedics cases 90% of the time. The facility's six-person anesthesia team has been proactive about pain control, implementing Enhanced Recovery After Surgery (ERAS) pro- tocols, managing patients' pain and expectations before they even walk in for surgery. The results, accord- ing to Otis Osei, DNP, CRNA, lieu- tenant commander and chief of anesthesia services, have been earlier discharges and increased patient satisfaction. The anesthesia team specializes in peripheral nerve blocks in order to minimize or prevent the use of opioids. Key to this program's success, however, is the anesthesia team's heavy involve- ment in data collection. "All patients get a call from the anesthesia team after surgery to assess pain control, recovery progress and sat- isfaction," says Dr. Osei. "This feedback has led to great improvements in the types of nerve blocks performed at the clinic." Dr. Osei cites an example of how this data collection leads to tweaks in techniques. "Last June, the anesthesia team discovered fascia ilia- ca nerve blocks were not adequate in relieving pain to the level of patient satisfaction, so they incorporated a new block called the pericapsular nerve group (PENG) block." Dr. Osei says the change led to a near-univer- sal improvement in pain scores and patient sat- isfaction. More compelling proof of the effective- ness of Kimbrough's peripheral blocks program, according to Dr. Osei: "The anesthesia team maintains a 100% discharge-to home-rate with no transfers of patients to emergency rooms." — Joe Paone EXCELLENT BLOCKING OR teams at Kimbrough Ambulatory Care Center benefit from their anesthesiology team's consistent collection of feedback from patients on the efficacy of their blocks. Chuck Yang