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J U LY 2 0 1 4 | 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
Regional Hospital,
describes his far-reach-
ing multimodal
approach as preemp-
tive analgesia, use of
regional blocks, PCA
[patient-controlled
analgesia], epidurals,
non-narcotics, cold
therapy and opiates.
It's likely to be non-
narcotic, as well. "I use
9 or 10 non-opioid
modalities to treat pain during the entire perioperative period," says Carrie
Frederick, MD, director of anesthesia services at a plastic surgery center in
Portland, Maine. "That's what multimodal means. It doesn't mean 1 or 2 other
modalities; it means multiple modalities at varying times in the perioperative
period and continuing post-op. If you understand the current concepts of pain
physiology, it's both insufficient and foolish to just be using narcotics to treat
pain."
Dr. Frederick says she doesn't use narcotics before or during the case. Nor
does she use IV meds in the recovery room on ambulatory patients. She gives
patients 3 Percocet to take home. "You must know if they have adequate pain
control on oral agents before you discharge them," she says.
Mind games
Pain control is a bit of a mind game for Charles A. DeFrancesco, MD, staff anes-
thesiologist at Delmont Surgery Center in Greensburg, Pa. Dr. DeFrancesco says
his strategy for managing post-op pain begins long before the patient is wheeled
into the OR. Pre-operatively, he ensures that his patients have realistic expecta-
P O S T - O P E R A T I V E P A I N
"Multimodal means multiple modalities
at varying times in the perioperative
period and continuing post-op."
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