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P A I N
C O N T R O L
• Ketamine. Administering this drug in small doses (0.5mg/kg at
induction and 10mcg/kg/min intraoperatively) to narcotic-tolerant
patients helps control the wind-up pain phenomenon, a chain reaction
of stimuli that starts at the incision site and travels along peripheral
sensory nerves to the central nervous system to intensify pain.
• IV lidocaine. There's growing interest in administering IV infusions
of this local anesthetic to help control post-op pain. Research has
shown that delivering the drug intravenously at induction and in the
PACU reduces the amount of opioids needed to lower post-op pain
scores. As long as it's given in small doses — 1 to 3 mg/kg per hour —
IV lidocaine shows promise as a safe and effective addition to a multimodal pain regimen.
Acknowledge and act
Pain is subjective. If patients say they are in pain, you need to do
something about it. Acknowledge their pain and let them know you'll
control it to tolerable levels. How you chose to do so is critical. The
answer lies in multimodal analgesia that combines a series of effective
pain control methods aimed at limiting narcotic use while improving
patients' post-op comfort.
Managing patients' post-op pain demands striking a delicate balance
between anguish and euphoria. You want to treat pain, but you don't
want to over treat it, especially if patients are obese, have sleep apnea or
take medications that make them more prone to respiratory depression.
When it comes to preparing satisfied patients for timely discharges, narcotics should be your last option, not your first. OSM
Dr. Sinha (ashish.sinha@drexelmed.edu) is vice chairman of anesthesiology and perioperative medicine at Drexel University College of Medicine
in Philadelphia, Pa.
