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 6 1
Either way, setting patient expectations through educational programs is a
key component of any pain management program. Patients are going to be tak-
ing control of their post-op care, so they need to be fully versed in what they're
doing and what the issues are. We can't just say, Take this pill every 4 hours.
That's a simple directive that doesn't help patients understand the basis for the
regimen. They need to understand, for example, that if they're having issues, it's
better to take 2 medications that work differently, instead of a second medica-
tion that works the same way as the other medication they're already on.
Educating patients about the pain they might experience and the several steps
you'll take to control that pain will set realistic expectations about how they'll
feel after surgery. If patients are naïve about post-op pain and function in the
joint — which they often are — it can lead to high levels of dissatisfaction.
We've found that pre-operative classes effectively educate patients and their
families about the realities of the recovery process. By explaining what they'll
experience during and after surgery we can substantially ease the fears they
may have well before they show on the day of surgery. We provide booklets and
videos and reinforce the information through oral instruction. Patients have a
better idea of what to expect when they have interactive discussions with surgi-
cal team members. Decreasing anxiety is also part of the multimodal approach,
because failure to do so may increase sensitivity to pain.
Still striving
Severe post-op pain can prolong stays, increase readmissions and increase opi-
oid use, which may lead to PONV, low patient satisfaction and substance-abuse
issues. Arthrofibrosis and diminished range of motion in the joint are also close-
ly related to the degree of post-op pain.
We're still searching for the ideal multimodal techniques that would eliminate
the use of opioids or even remove pain entirely from the recovery equation.
Many of us had hoped that injections of bupivacaine liposome around the surgi-
