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P A I N
&
P O N V
potentially eliminate narcotic use altogether. Patients who receive
nerve blocks do remarkably well after surgery, and limiting or eliminating narcotic use leads to less PONV.
It's also amazing how efficiently patients with effective nerve blocks
move through the facility. They receive fewer pain medications, have
virtually no PONV and enter PACU close to pain-free. They're therefore up and eating and drinking soon after leaving the OR, move
quickly to step-down recovery, meet with loved ones (a definite
patient satisfier) and are discharged to home in a timely manner.
Patients are also coherent and comfortable when listening to post-op
instructions, which leads to better at-home care.
Patients with histories of PONV or high-risk warning signs receive
scopolamine patches in pre-op. We closely monitor their fluid levels
and keep them in constant balance. We notify our anesthesia
providers of the increased PONV risks so they can limit narcotic use,
give anti-emetics ondansetron or dexamethasone prophylactically and
deliver fluids liberally.
Fluid imbalance in patients is a big issue that can heighten PONV risk
— adequate fluid balance allows for more effective drug metabolism,
which contributes to lower required doses of pain medication, and
therefore less PONV. In high-volume ortho facilities like ours, where
things run on time and efficiency is key, patients are prepped and
brought to the OR in short order. Pre-op nurses must be aware of this,
and flow IV fluids generously. Anesthesia providers and PACU nurses
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O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | M A R C H 2013
