3 8 S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E A U G U S T 2 0 1 7
experiences, education and preferences
of surgeons and other members of the
patient care team. For example, one sur-
geon doing a rotator cuff repair might be
very cautious about using NSAIDs, while
another might use them very liberally. As
anesthesia providers, we may be able to
support or refute whether certain anal-
gesic agents have advantages or disad-
vantages, but we can't simply ignore per-
sonal preferences.
Similarly, the umbrella has to be large
enough to account for variability among
patients. Two patients may be having
exactly the same procedure, but if one is opioid naïve and the other has been
treated for addiction to opioids and is currently on buprenorphine, you have to
be able to tailor your approaches accordingly.
• Everyone's input matters. Developing optimal protocols requires a coordi-
nated effort on the part of all stakeholders, not just anesthesia providers. To
develop effective protocols, your anesthesia providers need to step outside the
OR and reach out to administrators, surgeons, physical therapists, pharmacists
and nurses, so the entire patient care team can tailor the overall pain manage-
ment pathway to meet the unique goals of everyone involved.
For example, my goal as an anesthesiologist is to keep patients comfortable
and as pain-free as possible. But patients also need to be functional after 6 or 8
weeks. So I work very closely with our physical therapists, and I understand
what they consider to be desirable outcomes. As such, if we're doing an arthro-
scopic release of a frozen shoulder, we have an agreement that these patients
are scheduled as the first case of the day and that they begin physical therapy
on the day of surgery and continue on postoperative days 1 and 2.
• TEAM EFFORT To develop optimal protocols, anesthesia
providers need to work with surgeons, physical therapists, phar-
macists and nurses.
Susie
Wilson
