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manipulate your pain meds the next morning."
Sometimes, blocks will begin to wear off before discharge. In that case, you'll
want to get pain meds on board while the patient is in post-op. Nick Stuardi,
CRNA, MSN, of the Riddle Surgical Center, says to start pain meds by mouth when
the patient can move his blocked limb. As he explains, when you administer a
nerve block, sensory loss happens first, then motor blockade. But as the block
wears off, the opposite happens — motor skills return before sensory feeling. In
the case of a blocked hand, patients will be able to move their fingers before they
can feel their fingers. It's time to get pain meds on board at the first sign of finger
wiggling, says Mr. Stuardi. "Start the meds before they leave and have them set the
clock from there."
Some patients might assume the stoic stance that pain is a normal byproduct of
surgery and that taking pain medication is a sign of weakness. Tell them "not to be
shy about taking the pain meds as they're prescribed the first 24 to 48 hours after
surgery," says Dr. Getz. "A lot of people are reluctant to take their pills until their
pain is real bad. Start early and take them regularly for the first few days."
3. Make it multimodal. At the Riddle Surgery Center, they attack
pain along its many pathways. Dr. Getz will sometimes augment opioids with
anti-inflammatories and muscle relaxers like Valium. "It's spasm and not pain a
lot of times," he says. He'll add Lyrica in certain cases. More recently, they've
been using IV acetaminophen and IV ibuprofen, says Mr. Stuardi.
Dr. Getz says a multimodal approach to pain has a significant side benefit. It
gives patients a sense of control, a feeling that they can manage their pain on
their own. This is part of the reason why he sends patients home with at least 2
pain medications, 1 of which is not an opioid. "It makes them feel like they have
some flexibility," he says. "Start with this. If it's not enough, you can use anoth-
er."
Dr. Getz says the top 2 pain-control challenges are ensuring that the pain med-
ication is both adequate and appropriate. Pain control is also procedure-depend-
P A I N M A N A G E M E N T
