Ambulatory_Anesthesia_2013_Layout 1 6/26/13 2:21 PM Page 25
P A I N
M A N A G E M E N T
price and quality, but a company's
placing subcutaneous local anesthetic
backing is almost as important as the
before performing these multiple-
quality of its device. Partner with a
injection blocks to ensure patient
company that helps you educate not
comfort. He also prescribes an NSAID
only your patients but your nurses as
to target the inflammatory pathway.
well, says Dr. Siwek.
The blocks cost these patients more
money (about $300 in some facilities),
2. Rely on regional
but are well worth the investment, he
Dr. Siwek says regional anesthesia
says.
makes a world of difference for his
breast augmentation and abdomino-
3. Prevent pain proactively
plasty patients. He performs bilater-
Just as you know that staples hurt
al paravertebral blocks with ropiva-
more than sutures, you also know that
caine for these patients, with the
it's always easier to prevent pain than
augmentation patients typically
to relieve it. "If your patient awakens
receiving a higher block (T2
pain free, you've done a good thing,"
through T7) than abdominoplasty
says Lou Stanfield, CRNA, a recruiter
patients (T5 through T10). These
at locumtenens.com. "Waiting to treat is
patients often receive propofol infu-
never as effective as prevention." For
sion or light general, which Dr.
major abdominal cases, Mr. Stanfield
Siwek says translates into "half a
recommends a preemptive strike of
MAC" of anesthetic agent, with no
intrathecal narcotics in conjunction
narcotic requirement.
with general anesthesia.
"With the propofol infusions,
ward and we avoid PONV, which is
4. Stay on top of patients'
pain
particularly notable in breast augmen-
"We've always found it helpful to edu-
tation patients, who tend to experi-
cate patients before the procedure,"
ence high PONV rates," he says. Dr.
says Ms. Berreth. "Let them know that
Siwek also notes the importance of
post-op pain in the facility and at
patients are much more awake after-
J U LY 2013 | S U P P L E M E N T
TO
O U T PAT I E N T S U R G E R Y M A G A Z I N E
2 5
