use are one of the main factors in extending patients' post-op stays.
"Their bowels won't move, they're sluggish, so they don't ambulate,
which increases risk of blood clots forming," he says. "We began to look
at ways to decrease those risks."
Colorectal patients can drink a carbohydrate-rich drink up to 2
hours before surgery, so they're more comfortable and hydrated
before entering the OR. After receiving the TAP block and an injection
of local anesthesia, once in the OR, patients receive an opioid-reduc-
ing multimodal cocktail of IV NSAIDs and muscle relaxants to reduce
the body's stress response. "The idea is to trick the body into thinking
surgery didn't happen," says Dr. Rosas.
It takes considerable initiative and teamwork to turn the germ of an
idea into a system-wide protocol for multimodal pain control and
enhanced post-op recovery, says Dr. Haas. It's a cliché to get buy-in
from physician champions when trying to make change happen, but it
works. "Getting input and approval from surgeons — that's when
everyone gets behind the movement and are more likely to use the
recommendations," he explains.
After educating surgeons, Dr. Haas and his colleagues focused on
informing patients. "They also have to understand that they're being
put on a pathway that focuses on controlling post-op pain," says Dr.
Haas, who was taken aback when he began surveying his patients
about their pain expectations. "It's amazing that some believed they
would feel no discomfort after surgery, which means they were going
to ask for a ton of pain medications." he says. "That's why it's impor-
tant to tell patients that they're going to feel some pain after surgery,
and that that's normal and acceptable. Simply setting realistic expec-
tations has made a tremendous difference in the amount of opioids
patients are using."
Anesthesia providers were brought into the loop. Surgeons at
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