Pain Society's latest
guideline
(osmag.net/o6APqP),
based largely on opi-
oid-sparing multimodal
regimens and regional
anesthesia.
Dr. Chou says caring
for these patients, who
tend to have poor sur-
gical outcomes,
requires plenty of pre-
op planning, often in
concert with a pain
specialist. "Opioid
tapering before surgery
is a reasonable strate-
gy, but that takes time to accomplish and requires significant expert-
ise," he adds.
In addition, the post-discharge plan has to get these patients back
down to their baseline doses as quickly as possible, says Dr. Chou.
"Hopefully," he adds, "we'll gather more evidence to put effective
management strategies in place moving forward, but clearly it's an
issue we're dealing with now."
Opioid-sparing practices
There's also the danger that patients will suffer through post-op pain
— either because their surgeons prescribed too-little or too-weak pain
medication or because their anesthesia providers haven't mastered
multimodal anesthesia, which involves combining non-opioid anal-
1 2 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • A P R I L 2 0 1 7
• INFILTRATION Injecting a long-lasting local anesthetic into the surgical wound can
produce post-surgical analgesia and reduce opioid consumption.
Peter
G.
Whang,
MD,
FACS
