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ORX Awards and the Winners Are ... - September 2014 - 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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6 8 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 | S E P T E M B E R 2 0 1 4 important to realize that pain does not easily fit onto a 0-to-10 scale. It's also unrealistic for a post-surgical patient to have pain as a 0 to 1 on the pain scale." The goal is not to eradicate pain, he says, but to manage it as best as possible, which often means using different modalities, one on top of the other, to eliminate gaps in pain relief and extend by minutes or hours the time patients are recovering at home in relative comfort. For example, rather than waiting for a regional block to wear off before patients get pain medication into their systems, Dr. Mundey instructs them to take a loading dose of opioids while the block is still working. Overlapping a block with an opioid means a patient will feel as well in your recovery room as he will hours later in his living room. For his mastery over the mystery that is surgical pain, Dr. Mundey is the winner of the OR Excellence Award for Pain Management. Here are the pillars to Dr. Mundey's pain management. Multimodal approach Morphine and other narcotics remain the gold standard for the treat- ment of acute pain, while regional nerve blocks, both single -shot blocks and nerve block catheters, are gaining popularity, says Dr. Mundey. Other adjuncts he commonly uses include muscle relax- ants like metaxalone or cyclobenzaprine, NSAIDs, anticonvulsants like gabapentin or pregablin, and tricyclic antidepressants, including amitriptyline or nortriptyline. As an example, he says a narcotic-naïve patient coming for a routine shoulder or knee procedure will get oral medicines in pre-op that include a long acting narcotic, an NSAID and possibly gabapentin. The patient will then get a nerve block 30 to 45 minutes before the proce- dure for adequate pre-emptive analgesia. In the PACU, he'll give short- acting narcotics for breakthrough pain and often another dose of oral

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