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O U T P AT 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 | O C T O B E R 2 0 1 5
A N E S T H E S I A A L E R T
The spike in patient satisfaction scores at
the Blue Springs Surgery Center in Orange
City, Fla., have coincided with the arrival of
anesthesiologist Daniel Sabatelli, MD, and
the multimodal cocktail he's been adminis-
tering to pre-op ortho, general and GYN
surgery patients.
"Our patients are much more comfort-
able in the recovery room, and on average
the patients are being discharged within
30 minutes," says Clinical Director Enivette
G. Ramirez, RN. "It's a positive effect that's
clearly attributable to Dr. Sabatelli's pre-
emptive analgesia regimen, as PACU nurs-
es who've worked when he has another
provider covering for him will attest."
The regimen, which relies on anti-inflam-
matories and other non-narcotic agents,
works multiple pathways to block post-op
pain. Here's an outline:
• dexamethasone IV, about 1 hour pre-op,
• ketorolac IV, about 1 hour pre-op,
• acetaminophen orally or IV, about 2
hours pre-op,
• consider ketamine at anesthesia induc-
tion, and
• consider oral clonidine, gabapentin or
additional pre-op meds for select cases.
Dr. Sabatelli's multimodal approach
also recommends the following options:
• the use of peripheral nerve blocks with
long-acting local anesthetics, as appropriate,
• the application of long-acting local
anesthetics at the surgical site,
• a bolus dose of hydromorphone at the
beginning of surgery,
• avoiding narcotic redosing during,
at the end of or after a case, and
• a combination of reduced-dose intra-
muscular ketorolac and low-dose oral
oxycodone for post-op pain.
— David Bernard
PREEMPTIVE REGIMEN
What's in Your Multimodal Cocktail?
z MIX MASTER
Dr. Sabatelli's mul-
timodal approach
addresses pain
ahead of time.
Blue
Springs
Surgery
Center
noted in 10% and 37% of patients, respectively.
Murphy, et al., (osmag.net/Jw7pGX) demonstrated that small degrees of
residual paralysis (TOF ratios of 0.7–0.9) are associated with impaired
pharyngeal function and increased risk of aspiration; weakness of upper
