the patient's skin. There are a couple theories as to how TENS works.
Some think the electricity from the electrodes stimulates the nerves in
an affected area and sends signals to the brain that block pain signals.
Others believe electrical stimulation of the nerves helps the body to
produce endorphins.
• Verbal judo in PACU. Are your nurses inadvertently conditioning
patients to ask for opioids after surgery by the questions they ask?
Next time you walk through the recovery room and watch a nurse
accepting a patient, Dr. Bear suggests you listen closely to the ques-
tions she asks. It's likely something along these lines — even when
the patient is resting comfortably: "Are you in pain? Where is the
pain? How would you rate your pain from 1 to 10?" Dr. Bear sug-
gests training your PACU nurses instead to ask, "Are you comfort-
able? What are you feeling?"
• Multimodal treatment before and after surgery. Dr. Bear antici-
pates that anesthesia providers will rely more heavily on using different
pathways for pain relief. "The combination includes medications from
different groups, such as NSAIDS, opiate agonists, neuromodulators,
muscle relaxants, along with field or nerve blocks," she says. "Work with
your surgeons and practitioners to ensure that post-op prescriptions
align with the medications that were started prior to surgery or in the
pre-op area." A key to multimodal success, she adds, is patient educa-
tion: "Patients must take the medication even if pain is being blocked
from a local anesthetic."
• Music and hypnosis. Dr. Bear is a big believer in the power of
music and hypnosis or guided relaxation. Some studies suggest that
music of any genre at 60 to 65 beats per minute can be as effective as
administering an IV anxiolytic at decreasing heart rate, respirations,
blood pressure and anxiety. To help the patient relax in the pre-op
area, let him select the music of his choice on a tablet or iPod and
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