Outpatient Surgery Magazine

No Guarantees - March 2017 - 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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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

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