P
atients who are discharged
hours after procedures that
used to require inpatient
stays to recover don't hurt
any less. Today's pain con-
trol methods must advance along with
surgical techniques in order to send
patients home safely and comfortably
after outpatient procedures that are
increasing in complexity. If you want to
extend the effects of analgesics for two to
four days post-op — a critical timeframe
in which pain is often at its worst — there
are two main ways to do it:
• Single-shot injections. Bupivacaine
liposome, a long-acting anesthetic, is
approved for local infiltration or for use
with fascial plane blocks and interscalene
nerve blocks. This single shot, adminis-
tered around the surgical site, is used
mostly for shoulder arthroscopies, rotator
cuff repairs, as well as total hips and total
knees. The non-opioid local anesthetic is
usually given intraoperatively and can pro-
vide patients with days of pain relief upon
discharge. After the drug wears off,
patients transition to a traditional mix of
oral analgesics as needed.
The risk of infection is lower than with
catheter placements involved in continu-
ous nerve blocks, and the single shots are
easier for providers to administer.
They're also easier to manage post-discharge
because there is less of a need for providers to be
available to communicate with patients in the days
immediately after surgery.
• Continuous nerve blocks. Peripheral nerve
catheters and pain pumps are good choices for
busy outpatient facilities, robust orthopedic prac-
tices or centers with affiliations with large hospital
programs. These high-volume operations are best
suited to administer continuous nerve blocks
because of the expertise needed in placing the
catheters, as well as the 24/7 on-call support
required for patients in the days after their proce-
dures. A facility that uses these pumps once a
month isn't going to be successful, for many rea-
sons: It needs the purchasing power of buying the
pumps in bulk to make the devices affordable; a
provider has to fill the pumps if pre-filled options
3 0 • S U P P L E M E N T
T O O U T P A T I E N T S U R G E R Y M A G A Z I N E • M A R C H 2 0 2 1
Extended Post-Op Pain Control
Continuous nerve blocks and long-acting
anesthetics provide patients with long-lasting relief.
Gary S. Schwartz, MD | Brooklyn, N.Y.
GUIDED IMAGERY Anesthesia providers use ultrasound guidance to place catheters in a targeted group of
nerves for improved post-op pain relief.
Pamela
Bevelhymer
