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P A I N M A N A G E M E N T "People are more comfortable with a multimodal approach that hits many different types of pain receptors," he says. "We use less opioids, but in actuality our patients are more comfortable and their pain scores are better." Dr. Rose's surgeons are happier, too, with the reduced reliance on narcotics and more comfortable CAN BLOCKS BENEFIT YOU? ferent people. Think of it as preemptive or preven- How Regional Anesthesia Can Make Your Job Easier tive analgesia. The textbook definition of multi- T modal analgesia is the administration of analgesia are patient satisfaction scores directly before surgical incision to prevent establishment of he backstage beneficiaries affecting how facilities are run, but central sensitization from incision or inflammatory of regional anesthesia? You. satisfaction scores looking specifically injury in order to achieve optimal post-operative Here's how a successful at pain management are being report- pain control. From a practical standpoint, it means block program makes a facility maned to Medicare. Decreased narcotic patients. However, surgeons use a different metric to countering pain's multifactorial nature. In order to ager's job easier: consumption, non-existent nausea, measure the effectiveness of post-op pain control: do so, you need a multimodal regimen that targets • Efficiency. Regional anesthesia earlier and more frequent family visits, after-hours calls. "I get fewer phone calls at night," each of the factors that cause pain with agents that contributes to faster patient quicker discharges to home and pain Dr. Rose remembers a surgeon saying. "People call resolve those factors. throughput. Whether it's getting scores less than 5 out of 10 at post-op you at night when they don't feel as well as they think Multimodal and preemptive analgesia become even patients discharged to home or from days 0 to 3 are all positive outcomes they should. Fewer of our patients are calling to com- more attractive when you consider that the major PACU to the floor, the key perioperthat patients are able to report, thanks plain about the pain they're in." goal in the management of post-op pain is minimizing ative times that you're held to regional anesthesia techniques. Legacy Emanuel will measure the effectiveness of the dose of medications to lessen side effects while accountable for look better with a Regional anesthesia programs its surgical pain management program against anoth- still providing adequate analgesia. regional anesthesia program in give you a reason to rest easy, er backdrop: the size of its reimbursement checks. In Opioids are part of the plan of attack, but by no place. knowing that not only are you doing this era of health reform law, where patient satisfac- means the be-all and end-all. A 2010 article in the • Economy. This efficiency saves what's best for your patients, but that tion scores will directly impact your reimbursement, Journal of Spine shows how a hospital improved you money and lets facilities that are patients are at home resting easy in how well you manage post-op pain means a lot more pain control and patient satisfaction by implementing running regional anesthesia proclose-to-complete comfort. than fast turnover and satisfied patients. To that end, grams continue to thrive in a competi- Dr. Rose has a tip to help manage patients' expecta- tive healthcare market. tions: "Don't tell patients that they're going to be pain-free. Tell them you're going to make them comfortable enough to take part in their rehab." — Emily DeBusk, RN • Patient satisfaction scores. Now more than ever, you're being held accountable for the care 'Multimodal pain cocktail' you provide your Multimodal analgesia means different things to dif- 3 2 SUPPLEMENT TO O U T PAT I E N T S U R G E R Y M A G A Z I N E | J A N U A R Y 2013 patients. Not only a multimodal pain regimen using scheduled dosing of acetaminophen, gabapentin and extended-release Ms. DeBusk (b lock nursing @g ma il.com) is a block nurse and PACU nurse at Baptist Health Care in Gulf Breeze, Fla., as well as the founder of BlockNursing (b lock nursing .com), which provides advanced regional anesthesia education. oxycodone along with pen dosing of short-acting oral oxycodone. Dr. Rose likes to administer non-opioids/multimodal therapy pre-operatively. He calls it his "multimodal pain cocktail." On arrival, patients receive acetaminophen (Tylenol 650mg), a loading dose of an J A N U A R Y 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 3 3