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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 | J U LY 2 0 1 4
believe that it all starts with good local infiltration of the surgical site, others
swear by the newer non-opioids or continuous peripheral nerve catheters for
post-op pain. How do you control surgical discomfort? Let us count the ways.
Multimodal plan of attack
Each anesthetist follows a well-worn game plan. They can deviate from the plan
as the case calls for, of course, but the plan captures the essence of their pain
management philosophy. Learn the anesthetist's go-to pain-control move, and
you learn much about the practitioner,
Daniel K. O'Neill, MD, associate director of adult off-site anesthesiology serv-
ices at NYU Langone Medical Center in New York, N.Y., uses sodium channel
blockade for antinociception whenever possible. "Dose opioids generously prior
to incision," he says, "and titrate based on respiratory rate during emergence."
Then there's Patricia Cherniawski, CRNA, APN, of Whitney and Ramsey Oral
and Facial Surgery Center in Harrisonburg, Va. "Decadron early in induction and
surgeons instilling local with epinephrine injection before incision," she says. "I'll
often use Benadryl for more anti-inflammatory, antiemesis and sedation proper-
ties. Occasionally ketamine up front on longer cases in a low dose, usually
20mg."
For Dave Berkheimer, CRNA, of RemCare Anesthesia Solutions in
Altoona, Pa., who specializes in same-day joint replacement, it's all about
nerve blocks. "Regional with ultrasound guidance has revolutionized pain
management," says Mr. Berkheimer.
Every anesthetist has a game plan. What's yours? Today more than ever, with
so many therapies and so many mechanisms of action acting on different pain
receptors available to you, your pain plan of attack is likely to be multimodal.
Multimodal analgesia is when you combine agents that have different underlying
mechanisms of action that work along different parts of the pain pathway. You're
usually able to reduce the dosage of each agent, and have fewer adverse effects.
Bruce Rioux, CRNA, director of anesthesia services at Millinocket (Maine)
P O S T - O P E R A T I V E P A I N
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