tions and in managing case costs — especially expensive implants.
"Doctors didn't necessarily care what an implant costs in the hospital
— they got the same fee regardless," says Mr. Uba. "Docs now have a
vested interest in the cost of an implant. Money they save goes
straight to their own pockets."
One strategy to control implant costs is to cap what you'll pay, says
James D. Slover, MD, an orthopedic surgeon at NYU Langone Medical
Center in New York. "Tell vendors that they're welcome to sell their
products so long as the price doesn't exceed X," says Dr. Slover. Also
4 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 • J U L Y 2 0 1 7
Buffalo's multimodal pain management regimen includes
steroids, regional blocks, anti-inflammatories and the "Hairy
Buffalo," a cocktail consisting of: tranexamic acid (2 grams), lipo-
somal bupivacaine 20 mg (22 gauge needle), morphine 10 mg,
bupivacaine 0.25% with epinephrine 10 mg and peripheral nerve
stimulation by NSS (Neuro-Stim System). Total volume: 80 cc for
hips.
Hip replacement patients also receive extended-release opioids
(OxyContin 20 mg BID or MS Contin 30 mg BID), short-acting opi-
oids (Percocet 5/325 mg or Norco 5/325 mg every 4 hours), anti-
inflammatory (Celebrex 200 mg BID or Mobic 15 mg daily), CTE
prophylaxis (enteric coated aspirin 325 mg BID x 4 weeks), treat-
ment for constipation (Senna-S daily [softener and laxative] or
Mag Citrate 150 mL BID), antibiotics (Keflex 500 mg QID for 1
day), treatment for urinary retention (Flomax 0.4 mg once) and
antiemetic (Zofran 4 mg every 8 hours). The ASC discontinues
post-op opioids 3 months following surgery.
— Dan O'Connor
HAIRY BUFFALO
Multimodal Pain Management
