Outpatient Surgery Magazine

Year of the Nurse - November 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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T he use of continuous nerve blocks to man- age post-op pain pro- vides many benefits. Patients require fewer opioids, which lowers their risk of opioid misuse and elimi- nates prolonged PACU stays caused by opioid-related side effects such as nausea, vomiting, urinary retention and sedation. They leave your facility sooner and feeling good, which increases their overall level of satisfaction with the care you provided and pleases surgeons who appreciate answering fewer calls from dis- tressed patients in pain. My anesthesia group performs 10 times as many blocks at the Texas Medical Center's trauma center than we did when I became director of regional anes- thesia five years ago. Our anes- thesia group also works at the ambulatory surgery center across the street, and we just began a study there to compare the cost of using blocks as a primary anes- thetic in place of general anesthe- sia. We think the study will show what we already suspect: Regional anesthesia is significantly less expensive — and just as safe. To manage post-op pain, our team administers single-shot blocks with the option of extending the analgesia with a catheter attached to a pain pump or a local injection of extended-release bupiva- caine — a long-acting, non-opioid medication. Single-shot blocks with bupivacaine and some sort of additive such as dexamethasone or clonidine provide adequate analgesia for 24 hours after the surgery, with the pain quickly tapering off after that. After the first post-op day, patients transition to whatever medication surgeons decide is neces- sary — acetaminophen, ibuprofen or celecoxib, for example — and an opioid to control break-through pain as needed. Total joint replacement patients are ideal candi- dates for prolonged block durations because signifi- N O V 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 • 5 5 The Case for Continuous Nerve Blocks New technology and advancing techniques could make extended pain relief the norm in same-day surgery. Nadia Hernandez, MD | Houston BUILDING BLOCK Regional anesthesia can reduce the amount of opioids patients need, which makes for faster discharge times and increased patient satisfaction.

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