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Finally, as the procedure is completed, surgeons deliver what the hospital calls its RECK solution — a combination of ropivacaine, epi- nephrine, clonidine and ketorolac that's injected into the joint. The cocktail has helped eliminate the need for IV patient-controlled anes- thesia, which nurses had noted tended to make patients groggy and sluggish. In fact, it's been so successful that surgeons are also now using it for other procedures, too, including ACL repairs. "It's what allows the patient to get up and start moving," says Ms. Ford. And move they do, starting their first physical therapy sessions on the day of surgery. The hospital turned one of its semi-private rooms into a gym. "We have an excellent physical therapy aide who works with them," says Ms. Ford. "It's interesting. They actually tend to start com- peting with each other." Staff, meanwhile, provide analgesics before physical therapy, which helps patients push a little harder and get maximum benefit from the sessions. Three for all When it's time to go home, patients have clear directions and clear expectations, having been given discharge instructions 3 times. "One of the things patients were telling us in surveys was that discharge instructions weren't always clear," says Ms. Ford. "Now we go over them before surgery, in pre-op and in PACU. And we give them to a family member." The instructions also cover how and when to safely use opioids, incorporating input from a pain medicine specialist about how to best S E P T E M B E R 2 0 1 7 • O U T PA T I E N TS U R G E R Y. N E T • 4 7 done about it. After extensive research, she suggested changing the lidocaine 1% injection to a combination of lidocaine 1% and Marcaine 0.5%. The result was a 95% increase in patient satis- faction of pain management. — Jim Burger