Dr. Blank notes that peripheral blocks and infiltration are also key
components of his practice. He's in the vast majority in that regard, as
we'll discuss.
Still, the willingness to reach for opioids as a primary agent isn't
unusual, says Gary Lawson, MD, chief medical officer at Quantum
Anesthesia in Sarasota, Fla. "Surgeons still primarily prescribe opiates
for post-op home use," says Dr. Lawson, who favors acetaminophen
and NSAIDs and, like Dr. Viscusi and others, counsels an "if-needed"
approach to opioids.
One disconnect
In many, if not most, regards, anesthesia providers and surgeons
appear to be on the same page regarding post-op pain, but our survey
reveals one notable exception. Surgeons were much more likely (38%
vs. 9%) to favor opioid-based combination agents, such as Percocet
and Vicodin; anesthesia providers were much more likely (44% vs.
14%) to lean toward full-scale multimodal approaches involving pre-
and post-operative acetaminophen, NSAIDs and gabapentinoids.
F E B R U A R Y 2 0 1 6 • O U T PA T I E N TS U R G E R Y. N E T • 1 2 1
• I prefer to place a catheter in the wound and send the
patient home with an elastomeric pump. 10.0%
I routinely employ these techniques in my ambula-
tory patients (respondents could choose more than
one answer):
• spinal 32.1%
• epidural 18.9%
• peripheral blocks 90.6%
• TAP blocks 32.1%
• paravertebral blocks 17.0%
• infiltration 84.9%
Regarding nausea, _______ .
• I routinely give "triple therapy" (scopolamine,
ondansetron and dexamethasone) to every patient to
prevent PONV. 33.3%
• I screen for risk of PONV and treat only those at risk.
25.4%
• I routinely give dexamethasone during the anesthetic.
23.5%
• I use only ondansetron. 5.9%
• I take a "wait and see" approach. 11.8%
SOURCE: Outpatient Surgery Magazine online survey,
January 2016, n=55
