Outpatient Surgery Magazine - Subscribers

Melt Your Job Stress Away - January 2014 - 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 64 of 142

Page 65 P A I N C O N T R O L • Ketamine. Administering this drug in small doses (0.5mg/kg at induction and 10mcg/kg/min intraoperatively) to narcotic-tolerant patients helps control the wind-up pain phenomenon, a chain reaction of stimuli that starts at the incision site and travels along peripheral sensory nerves to the central nervous system to intensify pain. • IV lidocaine. There's growing interest in administering IV infusions of this local anesthetic to help control post-op pain. Research has shown that delivering the drug intravenously at induction and in the PACU reduces the amount of opioids needed to lower post-op pain scores. As long as it's given in small doses — 1 to 3 mg/kg per hour — IV lidocaine shows promise as a safe and effective addition to a multimodal pain regimen. Acknowledge and act Pain is subjective. If patients say they are in pain, you need to do something about it. Acknowledge their pain and let them know you'll control it to tolerable levels. How you chose to do so is critical. The answer lies in multimodal analgesia that combines a series of effective pain control methods aimed at limiting narcotic use while improving patients' post-op comfort. Managing patients' post-op pain demands striking a delicate balance between anguish and euphoria. You want to treat pain, but you don't want to over treat it, especially if patients are obese, have sleep apnea or take medications that make them more prone to respiratory depression. When it comes to preparing satisfied patients for timely discharges, narcotics should be your last option, not your first. OSM Dr. Sinha (ashish.sinha@drexelmed.edu) is vice chairman of anesthesiology and perioperative medicine at Drexel University College of Medicine in Philadelphia, Pa.

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