Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
Issue link: http://outpatientsurgery.uberflip.com/i/491203
and/or acetamino- phen for patients with mild-to-moderate pain, or a small dose of IV fentanyl or hydromorphine for more severe pain before discharge home. With more non-opioid analgesics hitting the market, even more therapeu- tic options will soon be available to improve recovery for your surgery patients. Given the clearly demonstrated bene- fits, there's no reason not to shift to a multi- modal approach for pain management. OSM 5 6 O U T P A T 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 | A P R I L 2 0 1 5 F or patients who have chronic pain and are being treated with opioid-containing analgesic medica- tions, consider adding one or more of the follow- ing non-opioid analgesics to your multimodal approach: • Gabapentin/pregabalin. These gabapentanoid drugs are typically used to treat neuropathic pain. However, they can also reduce pain caused by damage to the nerves during sur- gery. For those suffering from chronic pain, consider having patients take a dose prior to surgery and again postoperative- ly, as studies have shown patients who take a dose before and after surgery suffer from less post-op pain. However, note that these do increase postoperative sedation in the elderly popu- lation. • Steroids. Steroids are also an effective option for patients with chronic pain or for those at an increased risk for PONV. Of the available glucocorticoid steroids, both dexamethasone and betamethasone have been found to provide synergistic effects in combination with other non-opioid analgesics. Some studies have shown that the opioid-sparing effects of these steroids can last up to 72 hours and can lead to shorter recov- ery times. • Ketamine. For those patients undergoing ambulatory surgery who are receiving long-term opioid analgesic therapy for chronic pain conditions, the addition of a small dose of ket- amine perioperatively has been shown to improve pain con- trol. The NMDA receptor antagonist works to block pain signals and doesn't depress breathing as much as other anesthetic and opioid analgesic medications. — Paul F. White, PhD, MD, FANZCA OTHER OPTIONS 3 Additional Considerations for Your Multimodal Plan Dr. White (whitemountainin- stitute@hotmail.com) is a clinical researcher in anesthe- siology, a research consultant at Cedars-Sinai Medical Center in Los Angeles and at the Research Unit of Anesthesia and Intensive Care at the Rizzoli Orthopedic Institute at the University of Bologna, Italy. He is also pres- ident of the White Mountain Institute, a private not-for-prof- it foundation.