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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J A N U A R Y 2 0 2 1 • O U T P A T I E N T S U R G E R Y . N E T • 3 9 Hospital. "If I can block the pain for two days, that's ideal," says Dr. Sinha. "Once the pain is under control, you're able to rehab better." Opioid usage in the pre- and intra-op phase has a compounding effect. "The more narcotics used in the OR, the more narcotics PACU nurses need to administer during recovery," says Dr. Sinha. Regional anesthesia mitigates this dangerous domino effect and ulti- mately gets your patients up and ready for discharge more quickly. When nurses give patients more narcotics, those patients are going to take longer to ambulate and go home, points out Dr. Sinha. "That defeats the entire purpose of man- aging post-op pain," he says. "Outpatient surgery is based on quick-in, quick-out care." Not only is regional anesthesia the ideal opioid- sparing analgesic technique for minimizing post-op pain in ambulatory surgery patients, the process itself has evolved significantly in recent years — with virtually everything being done with the preci- sion of ultrasound guidance and newer blocks resulting in speedier recoveries. Take the adductor canal block, which is becom- ing ubiquitous with knee surgery analgesia. "Historically, we used to do femoral nerve blocks because it provides excellent pain relief, but it does cause some muscle weakness," says Naum Shaparin, MD, director of pain services at Montefiore Medical Center in the Bronx, N.Y. "The adductor canal block can give patients the pain relief without the same type of motor effect." Superior, opioid-sparing pain relief isn't the only reason to utilize regional anesthesia whenever pos- sible. If your facility isn't reliant on regional, you could have a difficult time recruiting the top anes- thesiologists and CRNAs. "Regional anesthesia is one of the most popular and sought-after fellow- ships within the anesthesia community right now, so you can expect many more providers with signif- icant subspecialty and fellowship-level expertise to enter the field," says Dr. Shaparin. • IV formulations. Combining regional anesthe- sia with the right multimodal cocktail of non-opioid drugs is a proven way to keep patients' post-op pain at bay. In fact, outpatient facilities are increasingly using IV formulations of many non-opioid medica- tions, says Dr. Shaparin. He points out that IV aceta- minophen and three approved IV NSAIDs, as well as ketamine, magnesium and steroids such as dex- amethasone (Decadron), are often given to patients undergoing outpatient procedures. The challenge with these medications, according to Dr. Shaparin, is assessing the individual efficacy of any one medication in multimodal pain therapies because they're typically measured by their com- bined effect. "Acetaminophen, lidocaine and steroids are administered at the same time as peripheral nerve blocks, so it's difficult to say which one made more of a difference than the others," he says. Still, the overall effectiveness of the combina- tion is undeniable. "Collectively, multimodal techniques that include various IV medications and peripheral nerve blocks make a huge difference in controlling pain," adds Dr. Shaparin. LIQUID GOLD There's been a surge in use of IV formulations of drugs such as lidocaine, magnesium and ketamine. Pamela Bevelhymer