be a component of
all of your multi-
modal pain manage-
ment plans. There
are virtually no side
effects and it's a very
simple option that
effectively reduces
incisional pain.
Additionally, local
infiltration anesthesia alone works well for many superficial proce-
dures, such as knee and shoulder arthroscopies, and breast and hernia
surgery.
The benefits are many, especially in terms of its ability to reduce
opioid analgesic consumption and limit adverse postoperative side
effects, speeding up your patient's recovery. While a simple lidocaine
and/or bupivacaine infiltration is highly effective for many proce-
dures, the inclusion of a parenteral NSAID (ketorolac 15 to 30 mg IV,
for example) and glucocorticosteroid (dexamethasone 4 to 8 mg IV,
for example) can further reduce post-operative pain and tissue inflam-
mation.
Many anesthesia providers also include peripheral nerve blocks as a
part of their multimodal plan. Use of ultrasound-guided nerve blocks
appears to have improved the effectiveness of nerve block proce-
dures, in particular for more complex surgical procedures. For exam-
ple, for painful knee replacement procedures, combining a femoral
and obturator block has been clinically shown to be effective in
reducing overall post-operative pain.
Continuous peripheral nerve blocks have played an increasingly
important role in facilitating recovery after painful outpatient orthope-
dic procedures. While they come with their challenges — they can be
difficult to maintain in place when patients ambulate and reimburse-
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z MULTIMODAL METHODS IV acetaminophen is one option
to consider adding to your multimodal pain management plan.
Pamela
Bevelhymer,
RN,
BSN
