phen," he says. "The nurses in PACU tell me they have to give less
pain medication to the patients I bring in who have received Ofirmev.
When they do give pain medication, [they're] having to give smaller
doses."
Are you doing it right?
Multimodal or preventive therapy has been around for more than 15
years, but "we're still not doing it adequately," says Carrie L.
Frederick, MD, director of anesthesia services for the Plastic Surgery
Center in Portland, Maine. "Multimodal doesn't mean 2 or 3 modali-
ties, it means 4, 5, 6-plus modalities, including non-pharmacologic
modalities like cryotherapy."
The technique should encompass the entire perioperative process.
"Pain management must start in the pre-op period to attenuate periph-
eral and central sensitization," says Dr. Frederick, "and continue well
into the post-op period to attenuate the inflammatory component,
which lasts a minimum of 3 days' post-op."
The availability of a range of options will let providers fine-tune the
effect. "I personally use 7 non-narcotic modalities pre-incision, and 9
or 10 non-narcotic modalities in all," she says. "While this is not possi-
ble for all surgeries, using this many modalities should result in signif-
icantly diminished doses of narcotic needed."
It's important to keep in mind that the multimodal approach isn't a
single, universal, analgesic blueprint that works for every patient.
"One-size-fits-all anesthesia was once the norm," says Louis G.
Stanfield, CRNA, PhD, DAAPM, who practices at Mercy Medical
Center in Sioux City, Iowa. "It's still evident in some practices. The
key feature of a multimodal plan, however, is that it is tailored to the
needs of individual patients. Patients are not widgets, and we don't
work in a widget factory."
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