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
