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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1 0 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 tions of the degree of discomfort they may experience after their procedure. "Patients may expect to experience little or no pain," says Dr. DeFrancesco. "Post-operatively, when they realize that isn't the case, they may become anx- ious and think something is wrong, thus increasing their pain perceptions and analgesic requirements." Ms. Cherniawski agrees with the power of pre-op teaching. "Assure them they will be numb when they wake. Then tell them to elevate the surgical site, get plenty of rest and apply cold packs post-op," she says. "It's rare that anyone com- plains while they are still in the PACU. Most problems occur with hyperanxious patients and with patients with a long history of chronic pain and significant nar- cotic use." It's best to begin patient education in the surgeon's office with discussions of multimodal therapies and regional anesthetics, says a Texas CRNA. Top challenge in managing post-op pain Managing surgical pain is not without its challenges, from covering the cost of disposable pain pumps and dealing with "opiophobic" colleagues who under- dose analgesics intraoperatively to avoid respiratory depression, says Dr. O'Neill, to narcotic-dependent patients and impatient surgeons who don't want anesthetists to take the time to do blocks, says anesthesiologist Denise Weiss, DO, of Salina, Kan. A note on this last point: Since some blocks take up to 20 minutes to set, regional anesthesia requires a change in protocol. Many recom- mend using a separate block room when possible or bringing patients into the OR as soon as the room is clean and administering anesthesia while nurses set up the case. Early in the post-op recovery period, when patients are not fully awake and alert, it's often difficult to administer adequate analgesic medications — espe- cially opioids — without risking respiratory depression, says Dr. DeFrancesco. "Patients may be writhing in pain, but at the same time, not breathing adequate- ly," he says. "This is especially challenging in patients with obstructive sleep P O S T - O P E R A T I V E P A I N Pivotal studies have demonstrated the safety and efficacy of EXPAREL in patients undergoing bunionectomy and hemorrhoidectomy procedures. The clinical benefit of the attendant decrease in opioid consumption was not demonstrated. EXPAREL is a liposome formulation of bupivacaine indicated for administration into the surgical site to produce postsurgical analgesia. Important Safety Information: EXPAREL is contraindicated in obstetrical paracervical block anesthesia. EXPAREL has not been studied for use in patients younger than 18 years of age. Non-bupivacaine-based local anesthetics, including lidocaine, may cause an immediate release of bupivacaine from EXPAREL if administered together locally. The administration of EXPAREL may follow the administration of lidocaine after a delay of 20 minutes or more. Other formulations of bupivacaine should not be administered within 96 hours following administration of EXPAREL. Monitoring of cardiovascular and neurological status, as well as vital signs should be performed during and after injection of EXPAREL as with other local anesthetic products. Because amide-type local anesthetics, such as bupivacaine, are metabolized by the liver, EXPAREL should be used cautiously in patients with hepatic disease. Patients with severe hepatic disease, because of their inability to metabolize local anesthetics normally, are at a greater risk of developing toxic plasma concentrations. In clinical trials, the most common adverse reactions (incidence ≥10%) following EXPAREL administration were nausea, constipation, and vomiting. Reference: Gorfine SR, et al. Dis Colon Rectum. Dec 2011;54(12):1552-1559. For the Management of Postsurgical Pain The only single-dose local analgesic to UÊ Reduce or eliminate opioids with pain control for up to 3 days UÊ Without the need for catheters or pumps EXPAREL ® (bupivacaine liposome injectable suspension) ©2013 Pacira Pharmaceuticals, Inc., Parsippany, NJ 07054 EXP-AP-0039-201302 Please see brief summary of Prescribing Information on reverse side. For more information, visit www.EXPAREL.com Patient-Focused Pain Control That Lasts For Up To 72 Hours SS_1407_Layout 1 7/1/14 2:22 PM Page 10