extended-release OxyContin — and we encourage patients not to take
it. In fact, we tell them they don't even have to fill the prescription if
they prefer not to.
Which brings up another important point: Patients have to under-
stand that it's OK to have some pain after surgery, that they should
expect it (see "Pre-op Conversation Sets Tone for Opioid-sparing
Surgery" on page 28). When I consent patients in my office, I tell
them my expectations about pain management, and I tell them I want
to hear theirs. I explain that I don't expect them to be pain-free, but I
do expect to get them to where they're comfortable.
Almost invariably, they're relieved by that conversation. Because near-
ly everybody knows somebody — a brother or a friend or a colleague
— who's had a problem with opioids. Bottom line: To be a successful
opioid-sparing physician, you must have that conversation with your
patients.
Cookie-cutter techniques
I recently participated in a surgeon advisory panel charged with devel-
oping opioid-sparing surgical interventions. I was on the team that
developed ACL protocols. We got 8 of the top ACL surgeons in the
country together in one room, along with 3 outstanding anesthesiolo-
gists. Then we shut the door for a few days.
We looked at the anatomy of the knee, knowing that the anterior
femoral cutaneous nerve has 3 branches that provide pain after sur-
gery, and that there's also the infrapatellar branch of the saphenous
nerve. The approach we developed involves localized cutaneous
blocks to those cutaneous nerves. We then inject the site in which the
graft is taken. Whether it's the quadriceps, the patellar or the ham-
string, it's the same concept. You also inject the portals, the site where
the graft goes into the tibia, and the site where the graft comes out of
4 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 • F E B R U A R Y 2 0 1 9
