heading into surgery," says Dr.
Gulur. "It creates a positive mind-
set that potentially leads to
patients feeling less pain during
recovery."
Patients are also told to avoid
foods that inflame muscles —
including white bread and pas-
tries, fried foods, soda, red meats
and margarine — and instead
reach for food that fights inflam-
mation such as fruits, nuts, leafy
greens and fish.
After the initial pre-op appoint-
ment, the Duke team creates indi-
vidualized patient care plans,
which include patient-specific,
opioid-sparing prescribing recom-
mendations that the surgical team
can access and refer to on the day
of surgery. They include informa-
tion about the morphine equiva-
lent daily dosage chronic opioid
users are taking, medication com-
pliance issues that could affect a
patient's post-op care and physi-
cal or mental factors that could
impact the effectiveness of the
medications a patient is prescribed.
Dr. Gulur says it's also important to counsel surgeons on how to set
M A R C H 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 1 1 9
You can never be sure which
patients will suffer more than
others after surgery, but
these risk factors can help
identify those who might need
more of your attention as they
start down the road to recov-
ery.
• chronic pain
• chronic opioid use
• substance use disorders
• significant opioid
sensitivities or allergies
• depression
• anxiety
• personality disorders
• pain ruminations
Who's Going to
Hurt the Most?
RED FLAGS
