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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MD, of the Carlstadt (N.J.) Surgery Center, thinks all it takes is one bad outcome for surgeons to shy away from catheters. "Surgeons feel they get good outcomes from their single-shot techniques. Why add another modality to potentially cause more issues?" he says. But that attitude concerns anesthesiologist Gregory Hickman, MD, anesthesia director of the Andrews Institute ASC in Gulf Breeze, Fla., who sees continuous nerve blocks as an important component. "I don't think there's any evidence that shows any increased risk with catheters," says Dr. Hickman, a co-founder of blockjocks.com. "Certainly, we've not experienced any more risk." The point, says Dr. Hickman, is that "when you have a big surgery, like a total knee, the pain is going to last longer than 12 or 18 or 24 hours. There's pretty significant pain for 3 or 4 days." That's why Dr. Hickman and his Andrews colleagues call their pain- pump patients 24, 36, 48, 72 hours after discharge "every day until their pump is out," he says. Pain scores for Andrews Institute patients, he says, average between 1 and 2 on a scale of 10, and patients take only between 1 and 1.5 prescription painkillers per day once they're home. NSAIDs next The second most popular member of the anti-pain arsenal is NSAIDs, trailing blocks only slightly. More than 60% of respondents say they've incorporated NSAIDs into their pain recipes. Not surprising, says anes- thesiologist Eugene Viscusi, MD, chief of pain medicine and director of acute pain management at Thomas Jefferson University Hospital in Philadelphia. "Blocks and NSAIDs have the highest impact on pain man- agement. From a pharmacologic standpoint, NSAIDs — including celi- coxib, acetaminophen and gabapentinoids — are the triple oral non-opi- oid backbone to a multimodal platform." Acetaminophen (47%) is also a popular choice among respondents, as it should be, says Dr. Viscusi. OSM 9 6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J a n u a r y 2 0 1 7