Outpatient Surgery Magazine

Back To Work - June 2020 - 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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Page 81 of 116

medial unicompartmental knee replacements, I place an adductor canal block with long-acting bupivacaine liposome instead of regu- lar bupivacaine or ropivacaine, and add an iPACK block, which is an infiltration between the popliteal artery and capsule of the knee. Placing two quick blocks under ultrasound instead of using spinal results in fewer side effects and provides longer-lasting pain relief. Another example: During a combined bilateral breast reduction and abdominoplasty, I placed bilateral TAP blocks for the abdominoplasty and bilateral PECS I and II blocks for the breast reduction, taking care to calculate the total dose of local anesthetic given. I used a total of 100 mcg of fentanyl during the procedure. The patient awoke with no pain. 3. Enhanced recoveries I believe the single greatest obstacle preventing facilities from adopt- ing a robust nerve block program is a lack of knowledge about the costs involved. Many facilities simply don't understand the significant cost savings regional anesthesia provides in terms of improved patient outcomes. With the precision of ultrasound-guided nerve blocks, you can reduce or even eliminate patients' need for opioids during and after surgery. Decreased opioid usage reduces recovery times as well as associat- ed side effects such as post-op nausea and vomiting. It also greatly decreases the amount of time your staff spends in the PACU treating patients' pain. There's also the intangible element of patient satisfac- tion. Most patients now have an increased awareness of the dangers of opioids, and want to avoid using them whenever possible. Decreasing opioid use also speeds up patients' post-op ambulation and discharge times, which allows facilities to save staffing overtime dollars. 8 2 • O U T P A T I E N T S U R G E R Y M A G A Z I N E • J U N E 2 0 2 0

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