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.
