ingly becoming the stan-
dard of care when possi-
ble, and with good rea-
son, says Dr. Dorin.
"There are so many bene-
fits. It's the whole gate
theory of pain," he says.
"You're minimizing pain
by getting to the central
nervous system and slowing the whole wind-up phenomenon."
Patients tend to have less pain, even when the block wears off. If patients
wake up and need a little hit of fentanyl or hydromorphone, they'll still need a
lot less of the opiates than they would without the block, says Dr. Dorin.
But what about the patients who struggle with PONV, no matter what you do?
Dr. Dorin resorts to the "bullet":
25 mg of ephedrine administered intramuscularly. "I haven't seen it not work,"
he says.
Make sure your providers are skilled enough with ultrasound to use blocks
whenever possible. "Especially for middle-aged and older physicians, it may
seem a little daunting," says Dr. Dorin. "But find a way. Take courses, or invest
in a couple of ultrasound machines — refurbished ones if necessary — to get up
to speed. It doesn't take long. And it's extremely valuable and helpful."
2
Handing out home videos
The push for healthcare transparency is gaining momentum, and it, too,
can play a pivotal role in patient satisfaction. For example, while some
shudder at the idea of offering patients a video record of their surgeries — why
supply litigious types with potential ammunition — others say such fear can be
the real enemy.
1 6 S U P P L E M E N T T O O U T PAT I E N T S U R G E R Y M A G A Z I N E January 2015
z DRILLING DOWN Post-op surveys are crucial for
isolating issues, setting goals and improving performance.
