and non-steroidal anti-inflammato-
ries (NSAIDs) or cyclooxygenase
(COX-2) specific inhibitors forms a
solid foundation and provides far
better pain relief than either of these
medications on their own.
Multimodal combinations have
proven to reduce the need for opi-
oids, which in turn reduces opioid-
related side effects (sedation, nau-
sea, vomiting, urinary retention, and
ileus) that can delay recovery and
time to ambulation.
Regional analgesia techniques
(placing an adductor canal block)
for total knees — there is no need
for a regional block with hip surgery
— provide excellent post-op pain control and allow for timely discharges
to home.
• Periarticular injection. A local anesthetic infiltration of ropivacaine,
bupivacaine or liposomal bupivacaine is directed at the peripheral nerve
endings around the knee and hip.
• Adductor canal block. Increasingly, this block is beating out
femoral blocks for total knee procedures because of its ability to
allow for greater mobility immediately after surgery.
You'll also want to keep up with the research regarding iPACK
(Interspace between the Popliteal Artery and Capsule of the posterior
Knee) block, an exciting technique with the potential to provide even
greater pain relief than the adductor canal block. The iPACK block can
be used in conjunction with the adductor canal block and periarticular
A U G U S T 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 2 5
• EXTRA HELP Patients at high risk of suffering PONV should
receive a scopolamine patch in pre-op.
Pamela
Bevelhymer,
RN,
BSN,
CNOR
