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.

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10 • 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 E nhanced Recovery After Surgery (ERAS) protocols involve standard- ized care pathways that limit post-op pain with mini- mal use of opioids. Patients who enter the pathways often experi- ence less discomfort, require lim- ited narcotics and are able to move through the surgical experi- ence faster, comfortably and with fewer side effects. That sounds good on paper, but how does it play out in practice? "There are so many success stories," says Brooke Chidgey, MD, an associate professor of anesthesiology and a pain man- agement specialist at University of North Carolina School of Medicine in Chapel Hill. "I remem- ber the positive impact ERAS pro- tocols had on a patient who underwent a complex procedure to remove cancerous growths from his pancreas." The patient was instructed to drink a carbohydrate supplement two hours before surgery and arrived hydrated, which made starting the IV easier. In pre-op, he received an epidural and was given acetaminophen, pregabalin and celecoxib to preemptively reduce tissue inflammation and post-op pain. During surgery, Dr. Chidgey closely monitored the patient's fluid levels and managed his pain without the use of opioids. A day after the proce- dure, the patient experienced little pain and was able to ambulate. "His ability to get up and moving soon after such a significant procedure helped to prevent blood clots and pneumonia," says Dr. Chidgey. "Not having to administer IV opioids to manage pain levels also helped his intestines respond quickly, which is important after a big abdominal procedure." Surgery causes physiological stress, and the body responds to the physical trauma by trying to protect itself and working to heal, notes Dr. Chidgey. "These responses release stress hormones and inflammatory mediators that can cause swelling, nerve irritation and pain," she says. "If we can blunt Dan Cook | Editor-in-Chief Teaming Up to Improve Post-op Pain Control Multimodal analgesia delivered by a multidisciplinary team provides preemptive relief from the physical trauma of surgery. ANALGESIC APPROACH Preparing multimodal medication cocktails to attack pain in various ways is a key aspect of enhanced recovery protocols. Lynda Schoppe

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