M A R C H 2 0 1 7 • O U T PA T I E N TS U R G E R Y. N E T • 2 5
One Simple Trick to Preempt Post-op Pain
The magic of a 50 mg dissociative dose of ketamine just before incision.
W
ouldn't it
be great if
all your
patients emerged
from their anesthetic
pain- and PONV-free?
I've developed a
reproducible tech-
nique that lets you do
just that. The key
component: a
50 mg ketamine dose
2 to 3 minutes before
incision that protects
the patient's brain from incoming noxious pain signals soon to be deliv-
ered by the surgeon's scalpel. The premise is simple: Patients who've
had pain during surgery will have pain after surgery. So to prevent post-
op pain, you prevent intraoperative pain. Here's how my preemptive
analgesia technique works.
Block NMDA receptors
Regardless of whether patients are unconscious, skin injection or inci-
sion is an extremely potent signal to the brain that the "world of dan-
ger" has invaded the "protected world of self." The brain can't differenti-
ate between the mugger's knife and the surgeon's scalpel (or trocar).
There are other pain receptors, but no signal is more determinant of
post-operative pain than incision. It sets off serious internal alarms, and
puts the wind-up phenomenon in motion.
Anesthesia Alert
Barry
L. Friedberg, MD
• MEASURE THE BRAIN Measure the organ you're medicating with a brain monitor, says Dr.
Friedberg, who notes that monitoring changes in heart rate and blood pressure can't ensure
you're protecting the patient's brain from incoming pain signals.
Kisay
Sanchez,
RN
