Archive May 2019 XX, No. 5

The Future of Orthopedic Anesthesia

5 innovative, opioid-free ways to manage the most painful surgeries.

Jared Bilski

BIO

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MAGIC NUMBER Gregory Hickman, MD, medical director and director of anesthesia at the Andrews Institute Ambulatory Surgery Center in Gulf Breeze, Fla., leaves peripheral nerve block catheters in ortho patients for 4 days.

Here’s a look at 5 promising ways to tamp down the intense, persistent post-surgical pain of orthopedic surgery.

1. Continuous peripheral nerve blocks (CNBs)

With CNBs, a percutaneous indwelling (or perineural) catheter provides a continuous local anesthetic. CNBs can relieve pain for days after surgery, as opposed to nerve blocks that provide analgesia for hours.

“People are realizing that single-shot blocks don’t do much good, especially if you’re trying to minimize opioid use,” says Gregory Hickman, MD, medical director and director of anesthesia at the Andrews Institute Ambulatory Surgery Center in Gulf Breeze, Fla. He places CNBs in cases ranging from rotator cuff and labrum repairs to total-knee replacements.

So what’s the sweet spot for CNB usage? “We leave the block in for 4 days, and patients discontinue the use of the catheter on day 4,” says Dr. Hickman. “We used to only do 3 days, but we noticed patients had some pain on that fourth day.”

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