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"Surgeons have used combination agents for years and some are sticking to it," says Dr. Viscusi, who sounds a siren note of caution about the practice. "But combination agents tie your hands so you can't do around-the-clock acetaminophen. You don't want to have a patient on Percocet or Vicodin and then give them additional aceta- minophen, because of concerns about liver toxicity. Instead, it might be worth thinking about doing your non-opioid as a standing around-the-clock medication and using a pure oral opioid as rescue." Regional raves Meanwhile, regional anesthesia continues its impressive advance among all providers, with more than 85% of respondents saying they prefer to do cases with regional anesthesia whenever possible and/or that they routinely employ regional and send patients home with con- tinuous catheters and elastomeric pumps. That's more good news for those battling to reduce reliance on opi- oids. "People seem to accept now that regional techniques really pro- duce excellent analgesia," says Dr. Viscusi, "and they're using them as the cornerstone of their analgesic and anesthetic approach." "Regional anesthesia and a multimodal approach should be the stan- dard of care," says a Florida anesthesiologist who counts himself among those who consider opioids a last resort. A strong regional program can also have other benefits, adds Jaime Baratta, MD, director of regional anesthesia at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia. "Regional anesthesia coupled with opioid reduction and multimodal analgesia improves throughput in the ambulatory setting by improving pain con- trol and reducing opioid side effects," she says. On the other side is a small minority (4%) who say regional is too burdensome, or that other obstacles stand in their way. "I used to use 1 2 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • F E B R U A R Y 2 0 1 6