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narcotics before discharge.
Timing is key, says Dr. Mundey. Most nerve blocks will last 10 to 12
hours, much longer in many patients. He instructs the patient to start
his oral pain meds as soon as his next dose is scheduled upon arriving
home and to continue to take them around the clock as scheduled —
no matter if the nerve block hasn't worn off — until post-op day 1.
"An adequate amount of pain medicine will be in their system before
the nerve block wears off," says Dr. Mundey. He also sends patients
home with a muscle relaxant "since breakthrough pain can sometimes
be caused by muscle spasms."
Educate patients and family
When the patient wakes up in the recovery room and has minimal pain,
he might have a false sense of security that he won't experience pain,
says Dr. Mundey. This may lead him to skip his oral pain medication
until he feels pain, when the block has worn off, at which point it's too
late to successfully control.
Educate the patient and whoever will be caring for him at home on
the importance of the multimodal approach to treating pain. "This
might include calling the patient a day or 2 before surgery to explain
regional anesthesia and nerve blocks, stressing that a nerve block is
only a temporary relief from the pain and might only last 10 to 12
hours," says Dr. Mundey. Explain that the goal of the block is to get the
patient through the intra-op period, to keep him comfortable for the
recovery room and ride home, and to get him to start eating and drink-
ing so that he can take his oral pain medicines and continue taking
them without interruption, he says.
If the patient goes home with a peripheral nerve block catheter with
an infusion, Dr. Mundey gives him a phone number he can call with
any questions or concerns about pain management 24 hours a day.
