pain-free surgery. Most surgeons knew that was an unrealistic
expectation, but were also aware that that was the standard by
which they'd be measured. Many surgeons have relied on opi-
oids ever since to make their patients as comfortable as possi-
ble, so surgery's contribution to today's epidemic comes as no
surprise to those of us who have watched and perhaps con-
tributed to the troubling over-prescribing trend.
The biggest hope of minimizing post-op opioid addiction poten-
tial is to increase the awareness and implementation of the alter-
ative means available for managing surgical pain, including nerve
blocks, epidurals and IV acetaminophen. When all of those modal-
ities are maximized, it's truly incredible how comfortable patients
feel after even the most invasive procedures. If multimodal pain
control becomes common practice before, during and after all
surgeries, opioid use will drop precipitously. Of course, the hope
is that pharmaceutical researchers will also continue their search
for more effective non-opioid pain control options.
Forward momentum
Jack Welch, the former CEO of GE, once said if your rate of inter-
nal change is less than the rate of external change, you've already
become irrelevant. That's a sobering thought. Change is inevitable;
the only question is whether your facility will be ahead or behind
the evolution curve. If you're simply maintaining your current
standing, you're actually falling further and further behind the
competition.
OSM
Dr. Talamini (mark.talamini@stonybrookmedicine.edu) is chair of sur-
gery and chief of surgical services at Stony Brook (N.Y.) Medicine and former
chair of surgery at UC San Diego, where he pioneered natural orifice translu-
minal endoscopic surgery.
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 • 7
