the end of the case. He does not allow any other blocks, even
though anesthesia is capable and willing."
Femoral blocks are still the most common, but adductor canal
blocks are gaining ground, likely spurred in part by a 2014 study
(osmag.net/nj2xfv) showing that they provide comparable pain relief
with less motor impairment.
"It's an evolution," says Dr. Levengood. "When I first started, we did
9 4 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J a n u a r y 2 0 1 7
Is there a potential killer in your pain arsenal? although respon-
dents to our survey on managing pain for total knees tell us
they're relying less and less on opioids, nearly one-fourth (24%) of
our respondents say they sometimes prescribe extended-release
oral opioids.
That's extremely alarming, says Eugene Viscusi, MD, chief of
pain medicine and director of acute pain management at Thomas
Jefferson university Hospital in Philadelphia.
"It's potentially a killer," he says. "Extended-release opioid for-
mulations have an inherently greater risk of respiratory depres-
sion than immediate-release formulations."
In September 2013, the FDa changed labels for all oral extend-
ed-release opioids to say that extended-release and long-acting
opioid analgesics should be reserved for patients for whom alter-
native treatment options are ineffective, not tolerated or would be
otherwise inadequate to provide sufficient management of pain,
and that they're not indicated for as-needed pain relief.
"There's no evidence that long-acting opioids provide better
pain relief than immediate-release. They only provide a higher
rate of respiratory events," says Dr. Viscusi. — Jim Burger
KILLER LOOSE?
Extended-Release Opioid Use Alarming, Says Expert
