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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best pain management techniques involve a multimodal or "balanced" approach. If your providers are still relying on opioid analgesics to treat and prevent post-operative pain because they believe it's the best solution, think again. Opioids come with many unwanted side effects that affect virtually every organ system in the body — producing hypoven- tilation, hypotension, sedation, nausea and vomiting, pruritis, urinary retention and ileus, as well as acute opioid tolerance. Opioid-related complications are harmful, especially in at-risk populations like the elderly. When coupled with the rapid pace of outpatient surgery, use of classic opioids like morphine and meperidine can be a serious detriment to an efficient and pleasant recovery. Since pain involves multiple mechanisms in the brain, spinal cord and peripheral nervous system, it's better to attack surgical-related pain by combining non-opioid analgesics that have additive or synergistic effects. Every doctor has his own favored combination, but the basic idea is simi- lar — reduce pain as much as possible using non-opioid analgesic med- ications, in particular regional and local anesthesia, with opioids serving primarily as "rescue" medication. Multimodal plans vary by provider, as each has his own "cocktail," but I've found the best multimodal plans for a quick recovery typically include the use of regional and/or local anesthesia, non-steroidal anti- inflammatory drugs (NSAIDs) and acetaminophen. Here's a rundown of some of the best options. Regional and local anesthesia Often in ambulatory surgery, general anesthesia, not the actual proce- dure itself, can be the biggest factor in when a patient returns home. Instead, consider the use of local tissue infiltration with local anes- thetics in combination with regional anesthesia involving a peripheral nerve block, if appropriate. Infiltration of local anesthetic around the surgical incision site should 5 0 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 O N L I N E | A P R I L 2 0 1 5