tocol for ACL repairs. He divides a combination of 20 mL Exparel, 40
mL of normal saline and 20 mL of 0.25% bupivacaine HCI amongst 8
10-mL syringes with 22-gauge needles. He then infiltrates the quadri-
ceps tendon, the subcutaneous tissue incision, femoral nerve field
blocks (lateral and medial), the saphenous nerve field block, the
arthroscopy portal incision sites, the tibial tunnel incision and the
femoral exit pin incision.
"ACL surgeries are a very common outpatient surgery and the young
people needing them are the ones that can be most prone to opioid
addiction," he says. "This protocol allows us to do opioid-free ACL
surgery."
Over-the-counter pain relievers
Tylenol or ibuprofen work well on a headache, but can they handle
the post-operative pain of outpatient surgery? Yes, says Asif M. Ilyas,
MD, FACS, medical director at the Orthopaedic Surgery Center at
Bryn Mawr (Pa.) Hospital. Dr. Ilyas's study found that non-opioids like
Tylenol and ibuprofen are as effective as opioids like oxycodone for
outpatient hand surgery.
The study included 100 patients scheduled for primary unilateral
carpal tunnel release (CTR) under local anesthesia, who were blindly
given either 5 mg of oxycodone, 600 mg of ibuprofen or 500 mg of
acetaminophen post-operatively.
"There was no clinically significant difference in pain experience or
pill consumption whether patients received an opioid or non-opioid
after surgery," says Dr. Ilyas, also the program director of the hand
surgery fellowship at Rothman Institute and professor of orthopedic
surgery at Sidney Kimmel Medical College at Thomas Jefferson
University, both in Philadelphia, Pa.
8 4 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • O C T O B E R 2 0 1 8
