blocks and other interventions to target the sources and pathways of
pain with a decreased reliance on narcotics — can sidestep side-
effects and speed recoveries, but it's not without a learning curve. So
we asked a panel of anesthesia providers for their advice on putting
the technique to use.
Lay the groundwork
"I have always believed that a multimodal approach to post-op pain is
best," says Charles A. DeFrancesco, MD, staff anesthesiologist at
Delmont Surgery Center, a high-volume plastics practice in
Greensburg, Pa. But, since patients' expectations can influence their
outcomes, he says, "pre-op education is an important part of this. The
patient needs to have a realistic expectation of what discomfort they
may experience post-op. Often, since cosmetic surgery cases are
strictly elective, patients may have the false impression that there will
be little to no post-op pain."
Pain is easier to prevent than treat, so make sure your providers get
an effective headstart with pre-emptive analgesia, says Dr.
DeFrancesco. "For maximum benefit, the drugs must be administered
pre-op, before incision or any noxious stimuli.
"Sometimes administering these in the proper timeframe can be
challenging at a busy ASC, as other activities may take precedence
and the need for other pre-op medications such as antibiotics must
also be administered in the same timeframe," he says, noting that the
IV drugs such as Caldolor (ibuprofen) and Ofirmev (acetaminophen)
that have come to market in the past few years have helped greatly in
this regard.
These new analgesics add efficiency on the other side of surgery,
too, says Jeff Cryder, BS, BSN, a CRNA at Scott & White Hospital in
Temple, Texas. "I've seen a really good response to IV acetamino-
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