good.
Dr. Viscusi
Post-op pain
is a mixed
pain syn-
drome.
We're mis-
takenly told
to think of it
as nocicep-
tive pain
alone, but the reality is that many patients have burning pain with
characteristics of what you'd describe as neuropathic signaling.
Gabapentinoids, which are antineuropathic agents, are extremely
effective when there is a high incidence of burning pain. Even in the
absence of neuropathic pain, they seem to have analgesic properties
of their own and reduce opioid requirements.
What role do regional blocks and local anesthetics play in your protocols?
Dr. Wagner Our strategy is to use nerve blocks for most patients
undergoing outpatient surgery. We're able to give them pain relief that
will last 8 to 48 hours, which gets them through a period of severe
pain without the need for other analgesic medications. Using nerve
blocks to limit that initial pain is one of our strategies to get people
home the day of surgery. But blocks wear off, so you need to give
patients the resources they need to stay comfortable.
Dr. Stamatos A bupivacaine liposome injectable suspension (Exparel) is
the first generation of a single-shot, extended-release local anesthetic,
and it's absolutely where pain control is heading.
4 0
O U T PAT 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 | February 2015
z LEAD BLOCK Using regional anesthesia to limit initial
pain is a key to sending patients home the day of surgery.
Pamela
bevelhymer,
rN,
bSN
