2 3
A U G U S T 2 0 1 4 | S U P P L E M E N T T O 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
ent, he adds. "Some procedures are going to hurt more than others," he says.
"Medications only give you so much pain control. You have to educate patients
that some amount of pain is going to be normal." The goal, he says, is "to make
the experience, which is going to be unpleasant, as pleasant as possible."
4. Tailor your blocks. Especially in hand surgeries, Riddle is tailoring
its blocks so that patients are more numb for less time. "They don't like the
detached feeling of their limb," says Mr. Stuardi. They'll use a lower concentra-
tion of local anesthetic so that the patient has a less dense motor block while still
maintaining a good sensory block. "It's the best of both worlds: Patients can
move their extremity, but they're still not having pain," he says.
5. For patients already on pain meds. Another concern, espe-
cially nowadays, is managing post-op pain in patients who regularly take pain
meds for back pain or some other chronic ailment. "Be sure to ask patients
what their exposure to opioids is," says Dr. Getz. If a patient is on a standing
dose of Vicodin, let's say, Dr. Getz will instruct him to continue with his normal
dosing and prescribe a different add-on narcotic like Percocet for breakthrough
pain. In such cases, he might ask the patient's pain management doctor to coor-
dinate the post-op pain relief. "Patients are happy dealing with one person," he
says.
Intraoperatively, they'll sometimes administer a stronger IV narcotic analgesic
such as Dilaudid to patients who are taking a standing dose of opioids. "But
we'll given that solely in the beginning of the case," says Mr. Stuardi. "We'll
frontload the medication so it won't impact discharge."
For opioid-users, regional blocks have been a true blessing. "An effective block
is the great equalizer no matter what kind of pre-operative narcotic dose the
patient has been taking," says Mr. Stuardi.
OSM
E-mail
doconnor@outpatientsurg ery.net
.
P A I N M A N A G E M E N T
