Outpatient Surgery Magazine

Throw Away The Script - February 2019 - Subscribe to Outpatient Surgery Magazine

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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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

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