began to ask nurses about surgeons' pain control practices and heard a
similar refrain: "We didn't think anything could be done differently to
manage pain. We figured this was just the way it is."
No, thought Dr. Haas, we can do better. That epiphany occurred a
little more than a year ago. Since then, Dr. Haas has teamed with col-
leagues and administrators to roll out an opioid-sparing pain control
regimen for all specialties across the Methodist Health System.
A protocol is born
Dr. Haas participated in a clinical trial that tested the efficacy of long-
acting liposome bupivacaine injections to manage pain following
notoriously painful hemorrhoidectomy. At the same time, leading col-
orectal surgeons at the national level and within the Methodist health
system were touting the effectiveness of transverse abdominis plane
(TAP) blocks to reduce pain following abdominal surgery.
Dr. Haas got the idea to combine the modalities. "Instead of the blocks
lasting 2 hours, we thought we could use the injections to stretch their
benefit to 2 or 3 days," he says. "That energized us and moved the effort
to reduce opioid use to the top of our agenda."
TAP blocks take 2 to 3 minutes to place under ultrasound guidance
and numb the muscles of the anterior abdominal wall. Placing the
blocks in conjunction with local injections of liposome bupivacaine
has significantly reduced the amount of opioids anesthesia providers
administer during surgery. The combination became the foundation
for the new pain management protocol.
Tricking the body
Alejandro Rosas, MD, an anesthesiologist at Houston Methodist
Hospital, has worked with Dr. Haas to develop and implement the facili-
ty's opioid-sparing practices. He says side effects associated with opioid
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