At Duke University Ambulatory Surgery Center, we feel we are blazing new trails toward better postop pain control. Our single-injection and continuous-infusion nerve block techniques are allowing us to routinely do procedures such as total shoulders, mastectomy, open inguinal hernias and unicondylar arthroplasty on an outpatient basis. We also use blocks for laparoscopic cholecystectomies, Nissen fundoplication, tubal ligations and ENT procedures. Soon, we will test the techniques for patients undergoing first-time total knee replacements.

Benefits of blocking
As someone who has experienced the traditional narcotics-centered approach to postop pain control, I perceive that this technique produces profoundly superior analgesia. Our blocks provide pain relief during surgery and for up to 15 to 72 hours postoperatively, depending on whether we use a single-injection or a continuous-infusion peripheral nerve block technique. In addition to the block(s), our typical pain control regimen includes NSAIDs. When the patient is able to drink, we administer acetaminophen and another NSAID such as ibuprofen around the clock for three full days. For patients with stomach or bleeding conditions that contraindicate a traditional NSAID, we may alternately use a COX-2 inhibitor.

Dr. Steele ('steel004@mc.duke.edu')) is an Associate Clinical Professor with the Duke University Department Of Anesthesiology.