A U G U S T 2 0 1 6 O U T P A T I E N TS U R G E R Y. N E T 5 7
ers opioid consumption
and reduces post-op
stays, all while minimiz-
ing complications.
Finding
the right mix
To keep patients comfort-
able enough to head home
hours after notoriously
painful orthopedic procedures, it's essential to attack the various ways pain is per-
ceived in the spinal cord, the peripheral nerves, the dorsal ganglia, and ultimately
the central nervous system and brain. Our current protocol has evolved over time,
undergoing many modifications as we've seen what works well, and what's not as
effective.
We've come to recognize the advantages of regional anesthesia, which we now
use on the vast majority of our patients. In addition to reducing blood loss and
preventing deep vein thrombosis, it avoids central nervous depression, places
less stress on the cardiopulmonary system, may modify the stress response to
surgery, provides excellent pain relief, and allows early painless range of motion
and weight bearing. We use general anesthesia only in those rare instances in
which the anesthesiologist is unable to perform the spinal or epidural anesthesia
for medical or technical reasons.
Parenteral opioids are the source of many of the negative effects of analgesic
therapy, so limiting their use is also a major principle of our multimodal
approach, which I've outlined here:
• In pre-op. About an hour before surgery, we administer preemptive anal-
gesia — usually IV acetaminophen, a relatively recent addition to the field that
we've found helpful. As a preemptive measure, IV acetaminophen helps pre-
vent the establishment of central sensitization and the amplification of pain.
• KEY INGREDIENTS A multimodal cocktail includes several medications designed to work
on different types of pain.
Pamela
Bevelhymer,
RN,
BSN
