Outpatient Surgery Magazine

Patient Experience - June 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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places 10 CRNAs and 5 physician-anesthesiologists throughout Florida. The maxim — general never fails but regional is iffy — no longer holds true, says Dr. Lawson. It helps that he no longer relies on anatom- ical landmarks and patient cooperation to place blocks. Now he places blocks with the precision of dual guidance: nerve stimulation and high- resolution ultrasound. For orthopedic cases, his go-to anesthetic consists of motor-sparing peripheral nerve blocks, such as the iPACK (interspaced between the popliteal artery and the capsule of the posterior knee) and adductor canal block, as well as oral diclofenac, gabapentin and acetamino- phen. For abdominal cases, it's oral diclofenac, gabapentin and acetamino- phen, as well as a TAP (transverse abdominis plane) block. The TAP block was initially used for such lower abdominal surgeries as prosta- tectomies and hysterectomies, but providers are now applying it to other locations, including the upper abdomen for patients who have laparoscopic cholecystectomy or other upper abdominal minimally invasive procedures. "You have to try to find and promote techniques that not only have clinical benefits, but are also fairly easy for providers to perform. Otherwise, it's difficult to get them to the point to apply them consis- tently," says Ed Mariano, MD, MAS, chief of anesthesiology and peri- operative care at the Veterans Affairs Palo Alto (Calif.) Health Care System. Opioid-sparing movement These days, you can't discuss post-surgical pain management without first talking about the opioid crisis. Few would disagree that opioid- sparing pain relief is desperately needed, so how is it that from 2010 J U N E 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 5 1

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