Dr. Sigman coin-
cides his use of
Exparel with a multi-
modal approach to
pain management
that includes
Tylenol, Celebrex
and, at times,
gabapentin.
Although he dis-
charges patients
with 5 oxycontin
immediate-release pills, Dr. Sigman discourages their use. "We tell
patients that we can't take away all the pain, but as long as it's reason-
able, try not to take the narcotics because they are so addictive."
Pre-op counseling
When Dr. Ilyas tried pre-operative opioid counseling, he started with a
group of patients undergoing carpal tunnel release. He was familiar
with studies where 76% of CTR patients filled at least 1 prescription
for opioids following surgery and 14% filled a prescription beyond 90
days after surgery.
His results? Patients who were counseled about opioid use used
fewer prescribed opioids than those without counseling. The coun-
seled patients also looked to nonprescription painkillers to help with
their pain more than those in the uncounseled group, Dr. Ilyas notes.
The study involved 20 CTR outpatients in each group (the counseled,
and the uncounseled). All patients were prescribed 10 pills of Tylenol
#3 (325 mg of acetaminophen and 30 mg of codeine) after surgery.
O C T O B E R 2 0 1 8 • O U T PA T I E N T S U R G E R Y. N E T • 8 5
• AROUND THE BLOCK Brandon Winchester, MD, performs thousands of blocks a
year.
Brandon
Winchester,
MD
