benefits," says Dr. Viscusi, "including cognitive preservation and ancil-
lary anti-inflammatory effects. I think you're going to see ketamine
coming back as a background infusion drug in a lot of anesthesia."
• Intravenous lidocaine infusion is also promising. "There are a lot
of data to support it," adds Dr. Viscusi. "It's a potent anti-inflammato-
ry, and it appears to reduce the inflammatory response to surgery. It
also seems to improve functional outcomes longer-term, even months
after surgery."
An intravenous version of the common NSAID meloxicam may also
be FDA-approved by the time you read this (March 24 is the targeted
approval date). It could provide a much faster onset of action and the
potential for sustained analgesia.
"Its once-daily IV dosing will appeal to many and will likely become
a useful tool in our pain armamentarium," says anesthesiologist D.
John Doyle, MD, of the Cleveland (Ohio) Clinic, before adding a cau-
tionary note about its use with elderly patients and those at risk for
renal injury.
A combination of bupivacaine and meloxicam (HTX-011) is also in
the pipeline and is designed to reduce inflammation and reverse the
acidic environment caused by surgery, "allowing enhanced penetra-
tion of bupivacaine into the nerves and thereby potentiating its
effect."
2 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 • A P R I L 2 0 1 9
We're still learning a lot
about opioid-sparing techniques,
because as a society we spent
many decades using opioids
as a crutch.
— Mohammad Piracha, MD
