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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 | A U G U S T 2 0 1 4
dose of pain meds on board as prescribed before the pain starts), go to the
emergency room (bad) or call the surgeon at 2 a.m. (really bad). Here's how
they manage pain at the Riddle Surgery Center, where the orthopedic team
boasts of pain control so "impeccable" that most shoulder patients report next-
day pain scores of 3 or 4 out of 10.
1. Debunk patients' myths about regional anesthesia.
For all the good they've done to revolutionize pain control, nerve blocks have one
potential drawback: They can give patients the false sense of security that they'll
feel as great hours later in their living room as they do right now in your recovery
room. "I feel great, doc," they'll say. "I don't know what you were talking about
when you said I'd have pain." You know how the story plays out: The regional
block wears off, the prescription pain pills hardly touch the pain and you get the 2
a.m. phone call. "You need to stress to patients that the block will wear off," says
anesthesiologist Derick Mundey, DO. "You don't know when it will wear off, but it
will. I've gotten enough of those calls in the middle of the night."
Patients might be led to believe that a regional block and a pain catheter will
leave them comfortably numb for 5 days. Your job is to temper expectations. Dr.
Mundey suggests calling patients scheduled to receive nerve block catheters in
the shoulder or knee a day or 2 before surgery to give them the straight scoop
about regional anesthesia. He'll
e-mail them a handout that details what they can expect with a block on the
first, second and third day after surgery. "The morning of surgery there's too
much anxiety and they're not listening," he says.
Dr. Mundey removes the mystique surrounding a surgical block, stressing that
it is temporary and fleeting. In 10 to 12 hours, it'll stop working, he tells them. "I
explain that the surgical block is what we put in the OR to lessen the amount of
anesthetic burden," he says. "I tell them it will get you through the ride home
and onto the couch."
He also stresses to patients who'll go home with a pain catheter (0.2% ropiva-
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