F E B R U A R Y 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 4 7
knees and total hips, all of which can be done outpatient. We also
have opioid-sparing spine protocols, trauma protocols for orthopedics
and protocols for specialties outside of orthopedics.
You can view all 10 "opioid-minimizing approaches" at
osmag.net/eU6McE. As you'll see, they're all very specific cookie-cut-
ter techniques, designed that way so there's zero confusion. The
videos show exactly where to put each of those 10cc syringes to get
the appropriate zone of action. You can watch them and within 24
hours become an opioid-sparing surgeon who'll have good outcomes
that are both predictable and reproducible.
CMS on board
An important piece of good news for those who want to help mitigate
the opioid crisis is that CMS is now willing to pay for opioid alterna-
tives for Medicare patients in the outpatient setting. That helps with
one of the major areas of pushback: the cost of Exparel, which is $330
for a 20-cc vial. That can be a budget-buster for many pharmacies,
even if surgeons want to practice opioid-sparing surgery. Fortunately,
at least one major commercial insurer is moving in the same direc-
tion. We hope the new approach will be carried over to the inpatient
LaVanture. "Patients who expect more pain have more pain."
Earlier in his career, Dr. LaVanture commonly prescribed opi-
oids for his post-op patients. Then, he started looking at how few
of his patients were actually filling those prescriptions.
"Now I prescribe very few," he says.
The key is always to get the conversation going early.
"You can't be afraid to talk to the patients," he says. "The most
important thing is talking to them and having that discussion."
— Matthew Nojiri
