Outpatient Surgery Magazine

Special Edition: Pain Management - March 2021 - 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.

Issue link: http://magazine.outpatientsurgery.net/i/1347514

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Page 5 of 35

body thinks local anesthesia, but cryoanalgesia is a peripheral nerve block," says Brian M. Ilfeld, MD, MS, a professor of anesthesiology in residence in the department of anesthesiology at the University of California San Diego and a leading voice in apply- ing cryo to treat surgical pain. That's important because there's a lot of miscon- ceptions about what it takes to perform cryo, pri- marily that the procedure is overly complicated. "This is patently false," says Dr. Wilton. "The land- mark-based knee application of cryo is simple to implement and is relatively easy to master if you are already ultrasound-proficient." The latter point should apply to virtually all new 6 • 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 anesthesia providers. "Almost all anesthesiologists coming out of residency are trained in how to place ultrasound-guided peripher- al nerve blocks," says Dr. Ilfeld, "and almost all local surgery cen- ters and hospitals have ultrasound equipment, so we don't have to fight to get the equipment like we did 10 years ago." Even so, comprehensive train- ing is an absolute must for any of your anesthesia providers who perform cryo. "Providers must be skilled in ultrasound-based nee- dle placement using a targeted in-plane approach — the needle enters the skin at the side of the probe — to confirm the location of the probe's tip," says Scott Rigdon, MPH, DNAP, CRNA, NSPM-C, a anesthesia profession- al based in Southwest Montana. "It's also essential to undergo some formal coursework and perform several cryo procedures with a mentor or in the presence of a device rep." Multiple applications Cryo is FDA approved for use on any sensory nerve and has a number of practical applications that can be put to good use by innova- tive, forward-thinking facilities. For instance, sur- geons often encourage patients to lose weight before joint replacement surgery. But if patients are suffering from severe joint pain, it's difficult for them to exercise. In these instances, anesthesia providers can use cryo about a month before proce- dures to reduce their pain and help them better pre- pare for their surgeries. At Mercy Mt. Shasta, Dr. Wilton uses cryo mul- tiple times per week to help patients prepare for surgery, treat chronic pain and reduce the opioid prescriptions needed following notoriously NEW CLASS Almost all anesthesiologists coming out of residency are now trained in how to place ultrasound-guided peripheral nerve blocks.

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