5 6
S U P P L E M E N T T O O U T P AT 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 | M O N T H 2 0 1 4
can also give a patient IV acetaminophen, which has no risk of any bleeding
issues."
Drs. Hickman and Dombrowski both tout the benefits of the steroid dexam-
ethasone as a post-op medication.
"Steroids like dexamethasone do several different things for patients," says Dr.
Dombrowski. "They're anti-inflammatories, and inflammation and pain are syn-
onymous. They also tend to prevent nausea, which is great, and they make you
feel better. You get a bit of a steroid high. That's a lot of benefit from a very cheap
medication."
Single-shot injections at the surgical site can also play a major role in multi-
modal therapies. "In abdominal surgery, the bulk of the pain is somatic, not viscer-
al," says Ashish Sinha, MD, PhD, vice chair of anesthesiology and perioperative
medicine at Drexel University College of Medicine in Philadelphia. "A shot of local
at the site can provide several hours of pain relief, which decreases the need for
narcotics." Administering fewer narcotics lessens the risk of respiratory depres-
sion, limits PONV and lets patients ambulate sooner after surgery.
One of the cheapest therapies is also one that's often overlooked: ice. "That's
something people don't even think about," says Dr. Dombrowski. "It's simple, it's
easy and it has no side effects. Ice the heck out of the area and people tend to
have a lot better recovery. A lot of people don't do that."
While eliminating opioids, and the numerous problems attached to them,
remains a lofty — some would say unattainable — goal, one of the strengths of
multimodal therapy is that it's designed to minimize that need for narcotics, and
in so doing, it benefits virtually everyone involved —patients, surgeons, nurses
and administrators.
"If you use a multimodal approach and do it preemptively," says Dr. Hickman,
"you'll at least decrease the need for narcotics. It's really pretty simple. If people
read the literature and know these drugs, they're all good for analgesia. I just put
them together."
"We're trying to block or lessen each of the many different chemicals that
P A I N M A N A G E M E N T
1404_SurgerysHottestTrends_Layout 1 3/27/14 2:51 PM Page 56
