to family members. Finally,
we call patients the day
after they get home and
review the protocol one
last time.
The 3-day storm of
pain
The key to all of this is get-
ting patients through what I
call the storm of pain —
the first 3 days after sur-
gery. If you're simply giving patients a nerve block and sending them
home, that block is going to wear off in 12 to 18 hours. They may be all
smiles when they leave your facility, but then at the worst possible
time, like 2 or 3 in the morning, the block is going to wear off and
they're going to be miserable.
So, they'll start crunching down on the pain medication. But once
they're behind, they can't get ahead of the pain. Once it starts, there's
something about that kind of pain that makes it hard to keep up with.
Then what do they do? What they might do is end up taking opioids
for the next 6 weeks.
We're providing a soft landing for them, instead. We've done this
with hundreds of patients and they typically have a motor block for 24
hours, a sensory block for 36 hours and an analgesic effect that lasts
anywhere from 2 to 3 days. They're getting pain relief throughout that
72-hour window — the storm of pain. After that, the pain is usually
much more tolerable and manageable.
Incidentally, just in case, we also prescribe 5 doses of a short-acting,
immediate-release opioid — immediate-release oxycodone, not
4 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • F E B R U A R Y 2 0 1 9
• EASY ACCESS Anyone can quickly learn opioid-sparing protocols for
rotator cuffs, total shoulders, total knees, total hips and other procedures,
says Dr. Sigman, seen here doing a knee arthroplasty for a crowd.
Caitlin
Mahoney,
NP-C
