Outpatient Surgery Magazine - Subscribers

Secrets to Speedier Room Turnover - November 2013 - 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 97 of 156

OSE_1311_part2_Layout 1 11/6/13 9:40 AM Page 98 P A I N M A N A G E M E N T learned during 5 years in the military shaped how he approaches pain management today. "In the military you have to use a multimodal approach to control pain, because you don't want to make people drowsy and groggy," he says. "That just doesn't work on the battlefield." His current patients aren't headed into battle, but that's no reason to succumb to what he considers surgery's over-reliance on opioids. "Opioids don't take away pain, they just mask it," he says. "It's still there, but patients don't care as much. That's not what you want to do. The nature of the pain is what you want to address." The goal: balanced anesthesia The problems associated with opioids are well known. Beyond the epidemic of addiction they've wrought, they tend to be sub-optimal in outpatient settings because of their common side effects, including PONV, constipation, urinary retention and dry mouth. "Overuse of opiates in an outpatient setting can actually delay patients getting home because they're so drowsy," says Jane Ballantyne, MD, a world-recognized pain expert and professor of anesthesiology at the Hospital of the University of Pennsylvania in Philadelphia. "It can delay them feeding, and we like to see patients be able to urinate and take water before they go home. Use of opiates can delay both of those things." Dr. Lawson's alternative anti-pain toolkit, developed through years of experimentation and research, includes dexamethasone, ketamine (in very small doses) and ketorolac. Dexamethasone, a corticosteroid long recognized for its anti-PONV efficacy, was also shown in a 2011 study (tinyurl.com/n7yyqty) to be a "safe and effective multimodal pain strategy" at intermediate-dose levels (0.11 to 0.2mg/kg). It's a go-to analgesic for Dr. Lawson, who administers it intravenously pre-operatively. "It works for pain," he says, "because it prevents tissue edema, which stops the swelling that leads to pain." 9 8 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 | N O V E M B E R 2013

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