Pain Control in Ambulatory Surgery Centers

Description

Features easy-to-read text designed to appeal to a wide audience involved in the care of the perioperative patient Provides ample diagrams, tables and figures to help organize the information for easy reference Addresses specific physician and nursing concerns within pain management Foreword Preface Contents Contributors Part I: Introduction 1: Academic and Non-academic Ambulatory Surgery Centers and Hospital Outpatient Departments Introduction Definitions Trends Difference in Academic and Non-academic ASCs and HOPDs Funding Patient Selection Intraoperative Management Technique Discharge Outcomes of Surgeries Performed in ASCs and HOPDs Advantages of an ASC Advantages of a HOPD Pain Relief in ASCs and HOPDs Summary References 2: Opioid Epidemic Introduction Opioid Epidemic Acute Pain Pain Pathway and Molecular Mechanisms Treatment of Acute Pain Multimodal Analgesia and Opioid Alternatives Nonpharmacologic Treatments for Acute Pain Summary References 3: Current US Policy for Opioid Prescribing Introduction History of Opioid Prescriptions Federal Oversight State Oversight Recent Policy Initiatives Future Directions Limitations Summary References 4: Rationale and Goals for Optimal Pain Control in Ambulatory Surgical Centers Introduction Status of Pain Control in Ambulatory Surgery Centers Analgesic Goals in Ambulatory Surgery Centers Summary References 5: Challenges of Pain Control in Ambulatory Surgery Setting Introduction Causes of Inadequate Analgesia in ASCs Major Postoperative Concerns in ASCs Consequences of Inadequate Analgesia in ASCs Unique Aspects of ASC Versus Hospital OR Surgery in Relation to Anesthesia Techniques Regional Anesthesia in ASCs Adjuncts Dexamethasone Epinephrine Alpha-2 (α2) Agonists Buprenorphine Liposomal Bupivacaine Continuous Peripheral Nerve Block Catheters Criteria for Patient Selection Placement of CPNBCs CPNBC Discharge Guidelines Post-discharge Analgesia Summary References 6: Assessment and Optimization of Available Resources for Pain Control (In Ambulatory Surgery Setting) Introduction Preoperative Setting Preoperative Screening Pain Management Expectations Intraoperative Setting Multimodal Analgesic Interventions Modes of Drug Delivery Postoperative Setting Workflow Improvements Staffing Improvements Summary References 7: Benefits of Optimum Pain Control in the Ambulatory Surgery Centers Scope of Ambulatory Surgery Pain Management After Ambulatory Surgery: How Well Are We Doing? Consequences of Inadequate Pain Management Physiologic Changes Health-Related Quality of Life Transition to Chronic Pain Economic Burden Strategies for Postoperative Pain Control Surgical and Anesthetic Consideration Pain Management in PACU Pain Management After Discharge Regional Anesthesia for Postoperative Pain Intra-articular Opioids and Local Anesthetics Future Direction Patient Education References 8: Analgesic Strategies in Ambulatory Surgery Centers Introduction Preoperative Analgesia Regional Anesthesia Adjuvants to Regional Anesthesia Buprenorphine Magnesium Dexmedetomidine Clonidine Dexamethasone Epinephrine Liposomal Bupivacaine Continuous Perineural Nerve Block (CPNB) Neuraxial Techniques in Ambulatory Surgery Center Midazolam for Preoperative Anxiolysis Oral Preoperative Analgesia Selective Nonsteroidal Anti-inflammatory Agents Celecoxib Acetaminophen Gabapentinoids (Gabapentin and Pregabalin) Intraoperative Analgesia Ketamine Magnesium Lidocaine Opioid Analgesics (Fentanyl and Hydromorphone) IV Dexamethasone Intravenous (IV) Acetaminophen (Ofirmev) IV Nonsteroidal Anti-inflammatory Agents (Ketorolac) Dexmedetomidine Infusion Wound Infiltration Postoperative Analgesia Methocarbamol Lidocaine 5% Transdermal Patch Sample Combination of Medications References 9: Preoperative Planning of Acute Pain Management in an Academic Ambulatory Surgical Center Introduction Multimodal Analgesia as an Essential Part of Enhanced Recovery After Surgery (ERAS) Protocol (2019) Preoperative Evaluation Pain Management in an Ambulatory Setting Premedication Nonopioid Analgesics: Commonly Used Premedications Acetaminophen Nonsteroidal Anti-inflammatory Drugs (NSAIDs) Dexmedetomidine Ketamine Gabapentinoids (Gabapentin and Pregabalin) Dexamethasone Lidocaine Regional Anesthesia: Component of Multimodal Analgesia Adjuvant Drugs Anticoagulation Perioperative Pain Management in Patients on Chronic Pain Medications Percutaneous Peripheral Nerve Stimulation for Acute Postoperative Pain Summary References Part II: Multimodal Analgesia 10: Comprehensive Pain Management: Opioid-Naïve Versus Opioid-Tolerant Patients Introduction Pathophysiology of Pain and Opioid Tolerance Overview on Multimodal Analgesia Upper Extremity Surgery Lower Extremity Surgery Trunk Surgery Perineural Catheters Opioid-Naïve Versus Opioid-Tolerant Patients Preoperative Evaluation and Identification of Risk Intraoperative Considerations Postoperative Considerations Summary References 11: Opioid Use in the Treatment of Pain States Introduction Opioid Drugs Commonly Used for Management of Cancer Pain Morphine Oxycodone, Hydrocodone, Hydromorphone, and Oxymorphone Fentanyl Methadone Levorphanol Mu Agonists Rarely Used for Cancer Pain Codeine Meperidine Mixed-Mechanism Drugs Used in the Treatment of Cancer Pain Tramadol Tapentadol Agonist-Antagonist Drugs Used in the Treatment of Cancer Pain Buprenorphine Considerations in the Practical Use of Opioids Selecting the Opioid Opioid Use in Patients with Renal Failure Drugs to Use with Caution Meperidine Morphine Codeine and Tramadol Drugs for Use in Patients with Known Renal Disease Hydromorphone Fentanyl and Methadone Buprenorphine Opioid Use in Patients with Liver Failure Management of Breakthrough Pain Selecting a Route of Administration Oral Transdermal Rectal Subcutaneous and Intravenous Patient-Controlled Analgesia Intrathecal and Intraspinal Opioid Administration Dose Titration Pain That Responds Poorly to Opioids Switching to Methadone for Pain Control Management of Opioid-Induced Side Effects Opioid-Induced Constipation Opioid-Induced Sedation and Mental Clouding Nausea Respiratory Depression Pruritis Summary and Recommendations Choice of Initial Drug Titration and Switching to Modified-Release Formulations Breakthrough Pain Management Management of Pain That Is Poorly Responsive to Opioids References 12: Maximization of Non-opioid Multimodal Therapy in Ambulatory Surgery Centers Introduction Enhanced Recovery After Surgery Guidelines Preemptive Analgesia Acetaminophen NSAIDs (Nonsteroidal Anti-inflammatory Drugs) Corticosteroids Gabapentinoids Alpha-2 Agonists NMDA Receptor Antagonists Benzodiazepines Intraoperative Analgesia Postoperative Management and Pain Control Special Population: Geriatric Population Special Population: Pediatric Population Nonpharmacologic Pain Management Summary References 13: The Role of Ultrasound in the Ambulatory Setting Introduction Pain Treatment and Ultrasound Peripheral Nerve Blocks and Multimodal Analgesia Using Ultrasound in Outpatient Setting Upper Extremity Peripheral Nerve Blocks Lower Extremity Nerve Blocks Truncal Blocks Adjuvant Medications and Multimodal Analgesia Ultrasound Complications in the Ambulatory Setting PACU Discharge Criteria Important Clinical Findings Airway Assessment Transthoracic Echocardiography Neuraxial Anesthesia Vascular Access Sterilization Summary References 14: Use of Regional Anesthesia/Neuraxial Anesthesia in Ambulatory Surgery Centers Introduction Local Anesthetics Upper Extremity Blocks Interscalene Nerve Block Supraclavicular Nerve Block Infraclavicular Nerve Block Axillary Plexus Anesthesia Singular Block of the Radial Nerve, Ulnar Nerve, or Median Nerve Intravenous Regional Anesthesia Lower Extremity Blocks Femoral Block Adductor Canal Block Proximal Sciatic Nerve Block Popliteal Sciatic Nerve Block Ankle Block Neuraxial Techniques Legal Aspects Local Anesthetics Epidural Anesthesia in the Ambulant Setting Complications/Limitations of Regional/Neuraxial Anesthesia in ASCs Complications of Regional Anesthesia of the Upper Extremity Complications of Regional Anesthesia of the Lower Extremity Complications of Continuous Peripheral Nerve Blocks (CPNB) Complications of Neuraxial Anesthesia Important Clinical Findings Summary References 15: Ketamine Infusions: Role and Use in Ambulatory Surgery Centers Introduction Pharmacology Use in Surgery Centers Typical Workflow of an Infusion Future and New Directions in Pain Management and Beyond Economics Summary References 16: Management of Perioperative Nausea and Intractable Pain in Outpatient Surgery: Mechanisms, Strategies, and Clinical Considerations Introduction Intractable Pain in Outpatient Surgery Perioperative Nausea in Outpatient Surgery Role of Anesthesia in Outpatient Surgery Patient Selection Medical Considerations Social Considerations Surgical Considerations How to Plan Anesthesia in an Ambulatory Care Setting and How to Control Intractable Pain and Prevent Nausea and Vomiting Regional Anesthesia Neuraxial Anesthesia Choice of Analgesia Acetaminophen Nonsteroidal Anti-inflammatory Drugs (NSAIDs) COX-2 Inhibitors Gabapentin Ketamine Alpha-2 Adrenergic Agonists Opioids Choice of Antiemetic Agent Challenges for Pain Management in Outpatient Surgery Clinical Considerations Summary Bibliography Part III: NORA Locations 17: Sedation for Interventional Pain Procedures Introduction Locations Established Standards of Care Facilities and Equipment Personnel and Staffing Patient Evaluation Monitoring Drugs Procedures Patient Recovery Special Considerations Summary References 18: Sedation and Analgesic Considerations for Gastrointestinal Procedures Introduction Pre-sedation Patient Assessment Personnel and Equipment Patient Monitoring for GI Endoscopy Common Procedures in GI Endoscopy Choice of Sedation Agents Endoscopic Sedation in Special Patient Populations Recovery Special Considerations Summary References 19: Management of Perioperative Pain and Sedation for Interventional Radiology Procedures Introduction Pre-Procedure Considerations Pre-Procedure Imaging History and Physical Exam ASA Risk Stratification Bleeding Risk Contrast-Induced Nephropathy Adverse Reactions to Contrast Patient Positioning and Breath-Holding Peri-procedural Considerations: Sedation and Monitoring Post-Procedural Recovery Special Considerations by Location Fluoroscopy Suite CT Suite MRI Suite Special Considerations by Procedure Non-Vascular Procedures Chest Interventions—Biopsy and Thoracostomy Hepatobiliary Interventions Percutaneous Nephrostomy Adrenal Mass Biopsy and Interventions Vascular Dialysis Fistulas Aortoiliac and Peripheral Arterial Disease Interventions Transjugular Intrahepatic Portosystemic Shunt (TIPS) Endovascular Embolization and Percutaneous Ablation Uterine Artery Embolization Neurointerventional General Considerations Intracranial Aneurysms AVMs Carotid Angioplasty and Stenting References 20: Management of Perioperative Pain for Outpatient Bronchoscopy Overview of Perioperative Pain Management for Bronchoscopy Local Anesthetics Sedatives Analgesics Adjuncts Summary References Part IV: Special Patient Populations 21: Perioperative Management of Sleep Apnea Patients in an Ambulatory Surgical Setting Introduction Preoperative Evaluation Patient Screening and Risk Stratification Preoperative Optimization Intraoperative Management Medication Selection Regional Anesthesia General Anesthesia Postoperative Management Discharge Criteria Summary Recommendations Preoperative Intraoperative Postoperative Additional Sources 22: Special Considerations: Management of Pediatric Pain in an Ambulatory Setting Introduction Pharmacologic Therapy and Multimodal Analgesia Nonpharmacologic Therapies Peripheral Regional Anesthesia/Analgesia Upper Extremity Blocks Supraclavicular Nerve Block Interscalene Nerve Block Lower Extremity Blocks Femoral Nerve Block (FNB) Versus Adductor Canal Block (ACB) Sciatic Nerve Block Truncal Nerve Blocks/Other Peripheral Nerve Blocks Rectus Sheath Block Transversus Abdominis Plane Block (TAP) Quadratus Lumborum Block (QLB) Pudendal Nerve Block (PNB) Local Anesthetic Dosing and Adjuncts Pain Assessment Summary References 23: Pain Management in Former Addicts on Medication-Assisted Treatment (MAT) Program Background Who Is at Risk of Developing Opiate Addiction? Medication-Assited Treatment (MAT) and Its Availability Unique Preoperative Concerns Intraoperative Management Postoperative Management in Recovery Room Discharge Planning Weaning Plan Summary References 24: The Impact of Marijuana and Other Drugs of Abuse on Pain Control in Ambulatory Anesthesia Introduction Marijuana Marijuana-Pharmacology The Role of THC as an Antiemetic The Adverse Effects of Marijuana Consumption Cocaine Methamphetamine Ecstasy Bath Salts Vaping Summary References 25: Special Considerations – Indwelling Spinal Cord Stimulators and Intrathecal Pumps Introduction General Perioperative Concerns Management of Patients with Indwelling Spinal Cord Stimulator Preoperative Intraoperative Postoperative Management of Patients with Indwelling Intrathecal Pumps Preoperative Intraoperative Postoperative Discharge Planning Summary References Part V: Discharge Considerations 26: Discharge from Recovery Room in Ambulatory Surgery Centers Introduction PACU and PACU Discharge Difference in Discharge Criteria in ASC Recent Research Summary References 27: Recovery Room Protocols for Nursing in Ambulatory Surgery Centers (ASCs) and Hospital Outpatient Departments (HOPDs) Introduction Fast-Track Protocols Discharge Protocols Pain Assessment Pain Management Protocols Postoperative Nausea and Vomiting Protocols Hypothermia Nursing Protocols Regional Anesthesia Nursing Protocols Summary References 28: Weaning Protocols After Ambulatory Surgery Introduction Postoperative Pain Prescriptions as a First Exposure Multimodal Analgesics The Issue of Leftover Pills Planning for Discharge Short-Acting Opioids Postoperative Pain Management Service Summary References 29: Role of a Focused Ambulatory Pain Physician Introduction Rise of the ASCs Management of Acute Postoperative Pain Challenges of Managing Pain in the Ambulatory Setting Role of the Ambulatory Pain Specialist Multimodal Analgesia Managing the Chronic Pain Patient with Acute Postoperative Pain Managing the Patient with Opioid Use Disorder and Substance Abuse Considerations for the Future Summary References 30: Inclusion of Pain Management Services in Ambulatory Surgical Centers Introduction Pain After Surgery The Problem with Acute Pain Ambulatory Surgery U.S. Health Care and the Legislation Driving Change The Push Out of Hospitals and Into Ambulatory Surgery Centers Aligning Provider Payment with Value-Based Health Care Shift Toward Value-Based Health Care in ASCs Avoiding Costly Complications of Ambulatory Surgery The Evolution of Pain Management Services History and Evolution of Acute Pain Services Ambulatory Pain Management Pain Management Services at ASCs Advantages of Pain Management Services Considerations when Developing Pain Management Services Summary References 31: New Vistas in Ambulatory Postoperative Pain Management Postoperative Pain Management Multimodal Approach to Pain Control Optimizing Postoperative Analgesia with Liposomal Bupivacaine Nonopioid Pain Medications Appropriate Use of Opioids Ambulatory Pain Specialists Nonpharmacologic Pain Management and New Vistas TENS Cognitive Behavioral Therapies Acupuncture Music Therapy Other Nonpharmacologic Treatments Postsurgical Home Model Summary References Index