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Archive January 2021 XXII, No. 1

The Pillars of Post-Op Pain Control

Combining regional anesthesia with the right multimodal drug cocktail keeps patients' discomfort to a bare minimum.

Jared Bilski

BIO

EXTENDED PLAY
Pamela Bevelhymer
EXTENDED PLAY For notoriously painful procedures such as total joint replacements, long-acting local anesthetics can give patients effective relief during the initial post-op recovery.

With opioid-sparing protocols firmly positioned as the standard for managing post-op pain, surgeons and anesthesiologists have become masters of multimodal analgesia, perfectly combining a little bit of this and a little bit of that to send satisfied patients home in as little pain as possible. With that in mind, here are the key strategies that should be a part of your facility's pain management efforts.

  • Regional anesthesia. For notoriously painful procedures, nerve blocks — delivered via a single-shot block or continuously through the aid of a pain pump — have become a staple of opioid-sparing techniques in recent years. And for good reason. These blocks provide sufficient analgesia for 24 to 48 hours after surgery and, in some cases, even longer.

That's a critical window for managing post-op pain caused by tissue inflammation following the trauma of surgery. The inflammation maxes out in 48 hours and then rapidly decreases, says Ashish Sinha, MD, PhD, DABA, MBA, FASA, a professor at the University of California Riverside, and designated institutional official and program director of anesthesiology at UC Riverside/Riverside Community Hospital. "If I can block the pain for two days, that's ideal," says Dr. Sinha. "Once the pain is under control, you're able to rehab better."

Opioid usage in the pre- and intra-op phase has a compounding effect. "The more narcotics used in the OR, the more narcotics PACU nurses need to administer during recovery," says Dr. Sinha. Regional anesthesia mitigates this dangerous domino effect and ultimately gets your patients up and ready for discharge more quickly.

When nurses give patients more narcotics, those patients are going to take longer to ambulate and go home, points out Dr. Sinha. "That defeats the entire purpose of managing post-op pain," he says. "Outpatient surgery is based on quick-in, quick-out care."

Not only is regional anesthesia the ideal opioid-sparing analgesic technique for minimizing post-op pain in ambulatory surgery patients, the process itself has evolved significantly in recent years ­— with virtually everything being done with the precision of ultrasound guidance and newer blocks resulting in speedier recoveries.

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