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Battle Post-op Pain Without Opioids - April 2016 - 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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Hickman. "We used to use it a lot more, but now we tend to give it more orally and use the IV version in certain cases or as a rescue in PACU." More providers are also combining drugs traditionally used to treat seizures, like gabapentin or pregabalin, with an NSAID to provide pre- emptive analgesia, says Dr. Settles. "Especially in orthopedics, you'll see that the night before or the day of surgery, providers will have the patient take a little water and a combination of the 2, like gabapentin and celecoxib," she says. Steroids also play a role in these cocktails. Dr. Hickman notes that there's a growing movement to inject the corticosteroid dexametha- sone pre-operatively to ward off post-op inflammation and PONV. 5. Abuse-deterrent opioids While opioids have received a bad rep lately, they still can play a role in your treatment of surgical pain, says Dr. Settles. "[Opioids] still have a place in multimodal pain management," she says. New options — including Xartemis XR, an oxycodone and acetamino- phen formula designed to release the opioid slowly — have been specifically formulated to reduce abuse, according to the drugs' manufacturers. The key is finding the right balance, which often means limiting their use to treating breakthrough pain. "But you have to individualize the approach," says Dr. Settles. "Every surgery and patient is different. People try to make medicine an algorithm, but you have to understand the patient and any comorbidities, and tailor the medications to create the optimal plan." OSM 5 4 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • A P R I L 2 0 1 6

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