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P A I N
C O N T R O L
Soothing solutions
The push has been to move away from narcotics in favor of pain-controlling methods that don't cause the 2 major consequences associated with
powerful opioids: respiratory depression and potential addiction. An
effective multimodal approach to pain management includes combining 2
or more of the following: intraoperative dexmedetomidine, ketamine,
clonidine or remifentanil with NSAIDs (such as IV ibuprofen and IV acetaminophen) and local anesthetics.
• Local anesthesia. To limit the need for post-op narcotics, place
regional blocks whenever and wherever possible. Epidurals are a great
solution, as long as the pain is localized to a certain part of the body, usually under the nipples, as well as the lower extremities. Effective pain control
following upper-extremity surgery often requires continual nerve blocks.
• NSAIDs. These drugs control swelling, which helps lessen post-op
pain. It makes sense to use anti-inflammatories, but they have their
own set of associated post-op adverse events, such as impeding normal renal function. When combined with other modalities, however,
NSAIDs are very useful components of post-op pain control formulas.
IV acetaminophen is effective in patients with adequate liver function. In patients with good renal and liver function, you can combine
IV acetaminophen with NSAIDs to hit pain pathways and receptors
from multiple sides.
One dose of IV acetaminophen costs approximately $10, compared
with 10 cents per dose of morphine. Administrators and providers who
support the use of morphine to decrease their facilities' medication
expenses are missing the big picture of pain control.
Timely ambulation following surgery is the single biggest predictor of
quick discharge and decrease in post-op complications such as pulmonary emboli. Patients whose pain is well controlled, who aren't
over-dosed on narcotics and are pain-free walk sooner after surgery,
