For the surgery and postoperative pain management, patients receive a combination of multi-modal analgesia, regional anesthesia, extended-release liposomal bupivacaine and continuous perineural postoperative analgesia using an ambulatory infusion of local anesthetic. “No opiates are used during the surgical procedure or recovery,” Shepard says. “Patients are given a prescription for tramadol for moderate postoperative pain that may present. They are also given a prescription for a small number of oxycodone for breakthrough pain.”
Once home, patients are seen twice daily by a rehab provider and receive therapy, dressing and wound checks, pain checks and a vital sign assessment. “These visits continue until the patient is discharged to standard ambulatory therapy,” Sachs says.
The program, Shepard says, has been extremely successful, with most patients requiring zero or one oxycodone and an occasional tramadol. “There has been no significant opiate use. Our time-release local anesthetics and continuous local infusion provide almost complete pain relief for the first three postoperative days. Most patients reported no pain at rest and minimal and tolerable pain with therapy.
“When the local anesthetics wear off or are discontinued, all patients have been comfortable on only acetaminophen and nonsteroidal anti-inflammatory drugs,” he adds. “The program has been very rewarding for all of us at the ASCs and, most importantly, our patients.”