2 6 S U P P L E M E N T T O 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 A U G U S T 2 0 1 5
Studies have shown that using a combina-
tion of medications can help keep patients
comfortable after notoriously painful ortho-
pedic procedures. Here are the big players
to keep in mind:
• Acetaminophen and NSAIDs are
commonly used following orthopedic sur-
gery, both individually and combined.
Acetaminophen/paracetamol alone can
provide acute post-op pain relief for up to 4 hours in some patients, with few side effects. As a sole analgesic,
NSAIDs are more effective, but they come with concerns for bleeding, ulcers or renal dysfunction. Additionally,
there have been some questions over whether NSAIDs affect bone healing — though systematic reviews of
spine fusion have shown no negative effects.
One common solution is to use a combination of the 2 medications so NSAIDs are used for a shorter amount
of time or at a reduced dose. This also can improve pain relief: A 2010 study suggested the combination of parac-
etamol and NSAIDs may provide superior analgesia to either medication alone.
• Glucocorticoids are commonly used to improve analgesia and prevent post-operative nausea and vomiting.
Because of this, they can help patients recover quickly after surgery. For example, a single intraoperative dose of
dexamethasone has been associated with reductions in pain, opioid consumption and PACU stay. Studies have
also suggested that steroids don't impact infection rates or delay wound healing.
• Gabapentin-type drugs include gabapentin and pregabalin, which can reduce pain caused by damage to
the nerves during surgery. Studies have shown that patients who receive these drugs preoperatively often have
less opioid consumption and decreased pain following surgery. Plus, they seem to work particularly well for
orthopedic procedures.
• NMDA receptor antagonists are becoming more popular in outpatient procedures. Ketamine in particular
has been shown to work well for patients with chronic pain and opiate dependence. In one study, patients with
chronic pain who received ketamine intraoperatively reported decreased post-op pain intensity and morphine
consumption compared with those who didn't. Even more surprisingly, these patients reported that these num-
bers remained low at 6 weeks post-op, despite also reducing their opiate consumption over that time.
— Sylvia H. Wilson, MD
MULTIMODAL MEDS
What's In Your Pain Control Arsenal?
Pamela
Bevelhymer,
RN,
BSN
z FROM ALL ANGLES Attack pain along mul-
tiple pathways to optimize patient comfort.
