2 1
A U G U S T 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
caine) that it's only one-third the strength of the surgical block (0.5% ropiva-
caine). "When we send them home with pain catheters, we typically run them at
a diluted-down version," says Dr. Mundey. "We want them to get the sensation
back and move that [limb] again."
2. Don't forget the pain meds. At discharge, tell the patient's driv-
er to head straight to the pharmacy to fill the pain pill prescription, typically
Vicodin or Percocet, and perhaps muscle relaxants as well. Even though patients
don't yet feel pain, the trick is to get patients to take a loading dose of opioids
while the block is still working. "It's important to get pain meds in the system
before the block wears off," says Dr. Mundey. "It will hurt when the block wears
off. If you take the pain medication preemptively, you won't fall off of the ledge.
You want to put that warning in their minds."
Dr. Mundey tells caregivers to set an alert or an alarm on their smartphone
and administer a pain pill to the patient every 4 hours for the first 24 post-op
hours, disrupting their sleep if you must. "Don't let the block wear off complete-
ly and wake up with 10-out-of-10 pain. You'll wind up in the ER because you let
the pain get out of control," he says. "After the block wears off, then you can
P A I N M A N A G E M E N T
It's not realistic for orthopedic patients to
expect a pain score of 0 to 1 in the days
after surgery. But here's what anesthesiolo-
gist Derick Mundey, DO, of the Riddle
Surgery Center in Media, Pa., stresses to
them. If you comply with our multimodal pain
management protocol, your pain will be
manageable. A take-home pain catheter will
get you down to a 4 or 5. Add by-mouth pain
medication, and you'll be down to a 2 or 3.
WORKING THE PAIN SCALE
Set Realistic Pain Scores of 2 or 3 or 4
