Outpatient Surgery Magazine

Special Outpatient Surgery Edition - Megatrends - January 2018

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

Issue link: http://outpatientsurgery.uberflip.com/i/926595

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Page 52 of 66

J A N U A R Y 2 0 1 8 • O U T PA T I E N T S U R G E R Y. N E T • 5 3 you view the pain experience as individualized, you'll pick the thera- py that best matches the patient experience." Here's a quick look at 4 ways to customize pain management — some already in use, some you might not know about and some you have probably yet to try. 1. Ultrasound-guided nerve blocks "Our adoption of ultrasound has allowed us to be not only more selec- tive, but to also approach new sites of local anesthetic injections that weren't as accessible before," says Dr. Mariano. Interfascial plane blocks, which involve injecting local anesthesia in between connective tissue that surrounds muscles, are not yet widely used as replacements for epidurals during abdominal surgery, but Dr. Mariano says they have strong benefits. "The idea of these interfascial plane blocks is not necessarily to be better than epidural analgesia because for major abdominal surgery, epidurals are still the gold stan- dard," he says. "But a lot of patients are expected to ambulate sooner, and that demands finding analgesic techniques with fewer side effects." The TAP (transverse abdominis plane) block was initially used for such lower abdominal surgeries as prostatectomies and hysterec- tomies, but providers are now applying that block to other locations like the upper abdomen for patients who have laparoscopic chole- cystectomy or other upper abdominal minimally invasive proce- dures, says Dr. Mariano. It helps, he adds, that TAP blocks are easier for providers to place than interfascial plane blocks, which likely explains why interfascial blocks aren't widely used. "You have to try to find and promote techniques that not only have clinical benefits, but are also fairly easy for providers to perform. Otherwise, it's difficult to get them to the point to apply them consis- tently," says Dr. Mariano.

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