plane blocks for laparoscopic procedures, colon surgeries and hernia
repairs," says Dr. Langton, adding that those are typically accompa-
nied by injections of liposomal bupivacaine that provide up to 72
hours of analgesia.
Of course a few skeptical patients, having had the concept behind
regional blocks explained to them for the first time, cock their eye-
brows and decide they'll pass, says Ms. Rackers. "They're a little leery
because it's a new thing," she says. They decide on more traditional
approaches instead. And then the pain begins to kick in, and they
sometimes change their minds.
5 0 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • S E P T E M B E R 2 0 1 6
Plastic surgeon Matthew Schulman, MD,
has reduced opioid use in his New York,
N.Y., facility with a multimodal approach
that incorporates pre-operative, intra-oper-
ative and post-operative analgesia. Patients
receive 1,000 mg of acetaminophen imme-
diately before they're brought into the OR.
After induction, lidocaine is injected into the
surgical area, which reduces the need for
opioids. Then, during surgery, liposomal
bupivacaine is injected around the site,
which functions as a field and nerve block,
sometimes providing up to 3 days of pain control. Once awake,
patients get another 500 mg of acetaminophen and 220 mg of naprox-
en orally. As a result of the regimen, patients rarely require more than
10 mcg of fentanyl in the recovery room, says Dr. Schulman, and they
have less nausea, so they mobilize and recover faster.
QUICK RECOVERIES
Multimodal Regimen Fuels Speedy Discharge
• READY FOR DISCHARGE Patients rarely require more
than 10mcg of fentanyl in the recovery room.
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