3 8 • 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 U G U S T 2 0 1 9
The following drugs are in shortage. Thomas Durick, MD, a con-
sultant anesthesiologist with Envision Physician Services in
Walnut Creek, Calif., shares how to make do without them.
• Pain relievers. If morphine, fentanyl and hydromorphone are in
short supply, try ultrasound-guided regional anesthesia: intersca-
lene, supraclavicular, infraclavicular and axillary blocks for shoulder
and upper extremity surgery; femoral, adductor canal, popliteal and
iPACK blocks for lower extremity surgery; rectus sheath and TAP
blocks for hernia repairs and abdominoplasties; and PEC 1 and 2
blocks for breast and chest wall surgery. If blocks aren't options, a
multimodal approach that includes long-lasting infiltration of a local
anesthetic at the surgical site, NSAIDs and pre-op gabapentin can
help control post-op pain.
• Hydromorphone. Has been intermittently available.
Obtainable dosages (0.5mg/ml, 1mg/ml, 2mg/ml, 4mg/ml and
ADMINISTRATION AUDIBLES
• MORE WITH LESS When ketorolac is unavailable, acetaminophen is an effective pain-relieving option.
Workarounds for Drugs in Short Supply
