that results
when nerve
endings are
damaged by
surgery.
• Ketamine,
an NMDA
antagonist, is
proven to be
effective in
combating
acute postsurgical pain in one of the most challenging groups of
patients — those with chronic pain maintained on opioid therapy.
In fact, one of the biggest risk factors for developing chronic pain
after surgery is uncontrolled acute pain, making it that much more
important that you use an effective multimodal approach.
Local anesthetics, whether through wound infiltration or via a
peripheral nerve block, are also important components of pain man-
agement. Long-acting local anesthetics, such as ropivacaine or bupiva-
caine, may provide significant relief when given via wound infiltration.
Early studies suggest that Exparel, a liposomal bupivacaine formula-
tion that uses DepoFoam to enable time-release delivery, may provide
analgesia for up to 72 hours. So far, Exparel is only approved for use
in wound infiltration and not for peripheral nerve blockade.
Block time
Upper and lower extremity surgery is particularly amenable to periph-
eral nerve blockade, and many patients don't require opioids if they
have effective blocks. With continuous catheters and pain pumps,
1 1 0
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 | J U N E 2 0 1 5
z
ON TARGET
Dr.
Baratta uses ultrasound to
place
a peripheral nerve blockade. Blocks elim-
inate
the need for opioids for many patients.
John
Wenzel,
MD
