2 4 S U P P L E M E N T T O 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 A U G U S T 2 0 1 5
1. Opioids aren't the answer
While opioids are the old favorite, mul-
timodal plans that combine analgesic
medications with different mechanisms
to provide additive or synergistic
effects are especially effective for
orthopedic procedures. Plus, by reduc-
ing opioid use, you reduce opioid-relat-
ed adverse events that slow down
patients' recoveries.
The goal of a good multimodal plan is
to reduce the use of opiates to the role
of a rescue drug. Opioids have many
well-known, unwanted side effects. They may seem like a "cheap" and easy option
to treat pain, but they can come with additional unseen costs — such as longer
PACU stays. This is especially true in the aging patient population.
Instead of relying on opioids, the best pain control cocktail will likely include
a mix of antipyretics (acetaminophen and nonsteroidal anti-inflammatories),
glucocorticoids (steroids), alpha-2 adrenergic agonists (dexmedetomidine and
clonidine), gabapentin-type drugs (pregabalin and gabapentin), N-methyl-D-
aspartate (NMDA) antagonists (ketamine, magnesium, methadone and dex-
tromethorphan) and local anesthetics.
2. Consider newer, non-opioid options
While acetaminophen, NSAIDs and steroids are common in multimodal plans,
recent studies have looked at the benefits of newer non-opioid analgesics —
like pregabalin, gabapentin and ketamine — for orthopedic surgery, particularly
for spine and total joint procedures (see "What's In Your Pain Control
Arsenal?").
These studies have suggested that the use of gabapentin-type drugs pre-opera-
z A LAYERED
APPROACH Consider
using nerve blocks in
addition to oral med-
ications for painful
procedures like ACL
repairs, suggests
Sylvia Wilson, MD.
Pamela
Bevelhymer,
RN,
BSN
