OR Manager - May 2018 - 5

Editorial
Editorial
Continued from page 3
The study was based on more than
500,000 total hip and more than 1 million
total knee arthroplasties from the
Premier Perspective database for 2006
to 2016. Multimodal analgesia modes
included peripheral nerve blocks, acetaminophen,
steroids, gabapentin/pregabalin,
ketamine, nonsteroidal anti-inflammatory
drugs, or cyclooxygenase-2
inhibitors given on the day of surgery
or the day after. A total of 85.6% of patients
were given multimodal analgesia.
Among the total hip arthroplasty patients,
there were 19% fewer respiratory
complications and 26% fewer gastrointestinal
complications among multimodal
vs opioid-only groups, and a
12.1% decrease in length of stay (LOS)
(2 vs 3 median days). The researchers
note that reduced LOS did not lower
overall hospitalization cost-a fact they
believe could reflect " an increase in
utilization of resources for monitoring
and care in an increasingly comorbidityridden
population. "
The 85.6% rate of multimodal utilization
in this study shows widespread acceptance
of this concept, and many professional
societies support the practice.
However, the authors say more studies
are needed to better parse the effects
of the many different possible combinations
of drugs.
A few years ago, after undergoing a
parotidectomy for a tumor that turned
out to be benign, I asked my surgeon
to prescribe Tylenol with codeine rather
than the standard Percocet. I thought
I would tolerate the Tylenol better, but
because I could hardly eat anything,
even that quickly produced severe nausea.
I switched to regular Tylenol and
put up with the pain as best I could.
I had been told to eat " soft foods, "
but if I had it to do over again, I would
manage on a liquid diet. I have a fairly
high tolerance for pain, but mine was
ADVISORY BOARD
Kathy Adamson, MBA, RN, Administrative
Director, Trauma and Perioperative Services,
University of Utah Health, Salt Lake City, UT
Amy L. Bethel, MPA, RN, NE-BC, UnityPoint
Health, Des Moines, IA
Megan Beaton, BSN, RN, CNOR, Nurse
Director, Operating Room, Brigham and
Women's Hospital, Boston, MA
Mark E. Bruley, CCE, EIT, Vice President
Emeritus, Accident & Forensic Investigation,
ECRI Institute, Plymouth Meeting, PA
Mary H. Diamond, MBA, RN, CNOR, PMP,
Senior Director of Nursing, TriCity Medical
Center, Oceanside, CA
Michael A. Hofmann, BSN, RN, Regional
Director of Perioperative Services,
Ascension NE Wisconsin St Elizabeth
Hospital/Fox Valley Region, Appleton, WI
Casey Orth-Nebitt, BSN, RN, Director of
Surgery, Buena Vista Regional Medical
Center, Storm Lake, IA
Janet Dauphinee Quigley, MSN, RN, Nursing
Director, Postanesthesia Care Units,
Massachusetts General Hospital, Boston, MA
Kaye Reiter, MSN, RN, NE-BC, Vice President,
Surgical Services and Women's Health
Services, Summa Health, Akron, OH
John Rosing, MHA, FACHE, Executive Vice
President and Principal, Patton Healthcare
Consulting, Naperville, IL
Patricia C. Seifert, MSN, RN, CNOR, CRNFA,
FAAN, Independent Cardiac Consultant,
Falls Church, VA
Diane Skorupski, MS, RN, CNOR, NE-BC,
Interim Director of Surgery, Brigham and
Women's Hospital, Boston, MA
Dawn Vocke, MSN, MBA, RN, CNOR,
Clinical Director, Surgical Service,
UPMC St Margaret, Pittsburgh, PA
David E. Young, MD, Medical Director,
Preanesthesia Testing, Advocate Lutheran
General Hospital, Chicago, IL
more acute than I expected it to be, and
something as simple as better dietary
advice could have significantly reduced
my discomfort.
Pain thresholds are different for everyone,
and type of procedure plays a
role in those levels. When patients are
opioid abusers, pain management becomes
exponentially more challenging,
but practices like prehabilitation, enhanced
recovery after surgery, and multimodal
analgesia are evidence-based
best practices that produce better outcomes.
In
addition to these, I would say
managing patients' expectations with
a realistic and appropriate regimen for
postoperative pain control is a critical
component for success. ✥
-Elizabeth Wood
References
https://www.cms.gov/Newsroom/
MediaReleaseDatabase/
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Kessler A, Cohen E, Grise K. CNN Exclusive:
The more opioids doctors prescribe,
the more money they make.
Published online March 12, 2018.
https://www.cnn.com/2018/03/11/
health/prescription-opioid-paymentseprise/index.html.
Memtsoudis
S G, Poeran J, Zubizarreta
N, et al. Association of multimodal
pain management strategies with
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utilization. Anesthesiology.
Published online March 1, 2018.
Ramsay M A E. Acute postoperative
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Wood E. Evidence-based practice supports
adopting ERAS protocols. OR
Manager. May 2017;33(5), 15-19.
www.ormanager.com
OR Manager | May 2018
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https://www.cms.gov/Newsroom/ https://www.cnn.com/2018/03/11/ https://www.ncbi.nlm.nih http://www.ormanager.com
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