which, of course, opioids are one.
Dr. Viscusi agrees. "The ideal in my mind is to use around-the-
clock acetaminophen, non-steroidals, pregabalin and local or
regional anesthesia as a base, and then have the opioid become the
PRN," he says. "The ASA 2012 guidelines on the subject of multi-
modal analgesia don't preclude opioids — they preclude opioids as
a standalone or first-line agent."
But inevitably there are other views. Surgeon Jeffrey Blank, DPM, of
Foot First Podiatry in Crystal Lake, Ill., counts himself among those
for whom opioids are often a first choice, and the reason is simple. "A
lot has to do with patient expectations," he says. "If they expect an
opioid, and in their mind nothing else will work as well, I give them a
few days of an opioid and then switch them to something else." But
