Outpatient Surgery Magazine

Special Outpatient Surgery Edition - Orthopedics - August 2018

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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Page 55 of 86

"We're trying to be total perioperative physicians, not just intraopera- tive physicians," says anesthesiologist Zachary Turnbull, MD, the med- ical director of performance improvement and the director of the Center for Perioperative Outcomes at New York's Weill-Cornell Medical College. Experts are reassessing the hard-and-fast rule of fasting at midnight the night before surgery. New thinking on NPO involves having patients drink carbohydrate-rich supplements 2 to 3 hours before sur- gery. The developing concept is a definite satisfier for patients, who show up for surgery feeling comfortable and perhaps less anxious. They're also hydrated and nourished, and a growing body of research suggests patients who don't go NPO experience fewer post-op compli- cations and recover faster. "You want to consider what patients are doing at home," says Dr. Turnbull. "They have better outcomes if they eat well and are well hydrated, if they're exercising a little bit, if they're training for surgery and doing the right things for their body to recover from an insult. That lets us manage the intraoperative part in such a way that we maximize the post-op period and patient outcomes." 2. Maximized multimodal regimens To get at the root of post-op pain, you should attack it with a multi- modal approach (using 2 or more different methods or medications to manage pain) rather than using opioids alone, says Dr. Turnbull. Acetaminophen, COX-2 inhibitors and gabapentinoids are among the analgesics that address the "multitude of pathways" that can lead to pain. But here, too, there's a balancing act. "With Gabapentin and pregabalin, for example, there's definitely a pain benefit, and they do reduce the need for opioids," says Dr. 5 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 • A U G U S T 2 0 1 8

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