Outpatient Surgery Magazine

Obamacare, You're Fired - December 2016 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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Page 59 of 132

began to ask nurses about surgeons' pain control practices and heard a similar refrain: "We didn't think anything could be done differently to manage pain. We figured this was just the way it is." No, thought Dr. Haas, we can do better. That epiphany occurred a little more than a year ago. Since then, Dr. Haas has teamed with col- leagues and administrators to roll out an opioid-sparing pain control regimen for all specialties across the Methodist Health System. A protocol is born Dr. Haas participated in a clinical trial that tested the efficacy of long- acting liposome bupivacaine injections to manage pain following notoriously painful hemorrhoidectomy. At the same time, leading col- orectal surgeons at the national level and within the Methodist health system were touting the effectiveness of transverse abdominis plane (TAP) blocks to reduce pain following abdominal surgery. Dr. Haas got the idea to combine the modalities. "Instead of the blocks lasting 2 hours, we thought we could use the injections to stretch their benefit to 2 or 3 days," he says. "That energized us and moved the effort to reduce opioid use to the top of our agenda." TAP blocks take 2 to 3 minutes to place under ultrasound guidance and numb the muscles of the anterior abdominal wall. Placing the blocks in conjunction with local injections of liposome bupivacaine has significantly reduced the amount of opioids anesthesia providers administer during surgery. The combination became the foundation for the new pain management protocol. Tricking the body Alejandro Rosas, MD, an anesthesiologist at Houston Methodist Hospital, has worked with Dr. Haas to develop and implement the facili- ty's opioid-sparing practices. He says side effects associated with opioid 6 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 • D E C E M B E R 2 0 1 6

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