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Would You Operate On This Patient? - October 2015 - 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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5. Use a multimodal post-op pain management plan Following most spinal surgeries, patients will experience some level of discomfort. While traditionally this was treated with opioids, new multimodal plans help to avoid the negative side affects associated with opioids and manage patients' pain more efficiently. Compared to other surgeries, patients undergoing spinal proce- dures are more likely to already be using long-term opioids to treat chronic pain. A multi-pronged approach using some combination of local anesthetic, NSAIDs, gabapentinoids and/or acetaminophen can help control pain, especially for patients with a high opioid tol- erance. Additionally, some surgeons have success using pain pumps or a liposome injection of bupivacaine in more complex outpatient spine cases. Surgeons should work with anesthesia providers to develop a consistent pain management protocol. But sometimes with spinal surgery, patients feel more than just the typical discomfort. Post-op radiculopathy — where the patient has radiating pain that stays the same as it was before surgery or even increases dramatically — is a rare complication that does occur. Inflammation often causes post-op radiculopathy, but it can also be the result of misplaced instrumentation. Surgeons can decrease their odds of making these errors by using low-dose C-arms for intraopera- tive imaging, or newer spinal navigation systems to ensure their accu- racy during the procedure. Notify patients of the risk of post-op radiculopathy, and tell them in their discharge instructions to call their surgeon immediately if they're experiencing the same or increas- ing levels of pain or weakness in their back or legs after surgery. OSM 1 5 3 O C T O B E R 2 0 1 5 | O U T P A T I E N TS U R G E R Y. N E T Dr. Khanna (khannanit@hotmail.com) is a spine care specialist trained in minimally invasive surgical techniques at Orthopaedic Specialists of Northwest Indiana in Munster, Ind.

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