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M A R C H 2 0 1 4 | O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E
1. Grasp the potential
An effective multimodal approach to managing post-op pain is best
built with regional anesthesia as the cornerstone but, in my opinion,
more facilities should be taking advantage of blocks' many benefits.
My sense is there's still some resistance at the front line from facility
leaders who erroneously believe placing blocks is an added cost for
which they can't get reimbursed. Medicare won't reimburse for block
placements, and third-party payors won't pay for individual supplies
and medications, but you can bundle those expenses and get paid by
private payors by billing the procedure as a separate charge for the
sole purpose of preempting post-op pain.
In addition, veteran anesthesia providers who've never incorporated
regional into their practices are sometimes hesitant to try a technique
they believe increases intraoperative risks without adding a significant
financial payoff.
But regional can improve outcomes. For example, because pain is
controlled with fewer narcotics, our PONV rate is less than 1%, signifi-
cantly lower than the reported national average of 37%. That lets us
send happy patients home sooner, which has increased surgeon and
patient satisfaction.
Regional is primarily most effective in orthopedics, especially with
the added use of continuous catheters, which let our surgeons per-
form more invasive cases such as major knee and shoulder cases in
the outpatient setting.
It's no surprise, then, that our regional program has also helped
recruit surgeons, including 2 physician-owners of a local surgery cen-
ter who used to send us patients for placement of continuous
catheters. The docs eventually decided to reap the rewards of our
regional program on a full-time basis.
R E G I O N A L B L O C K S
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