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Optimizing Anesthesia and Improving Patient Care


February 10, 2017

During the recent American College of Perioperative Medicine Interdisciplinary Conference on Orthopedic Value Based Care, Sonia Szlyk, MD, Director of Regional Anesthesia, Mid-Atlantic Division, North American Partners in Anesthesia, Bethesda, MD, gave a presentation on the role of regional anesthesia techniques in optimal care pathways for individuals undergoing total hip and total knee replacements.  
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Dr Szlyk discussed the highlights from her presentation, titled “Regional Anesthesia for CJR/Multimodal Premeds & Chronic Pain Patients,” with Pharmacy Learning Network.

Regional anesthesia as a process in which local anesthetics are used to block pain sensations from specific areas of the body. In her presentation, Dr Szlyk explained that regional anesthesia leads to improved outcomes.

“Pain management is at the heart of the patient experience,” she said. “Regional anesthesia enables us to provide exceptional pain control while reducing opioid requirements. This reduces the risk of adverse related respiratory events and side effects such as nausea and vomiting.”

Opioid abuse is a serious problem in the United States. The US Department of Health & Human Services reports that 165,000 deaths since 1999 can be attributed to prescription opioid overdoses. Further, the United States spends $55 billion annually in health and social costs associated with prescription opioid abuse (http://bit.ly/2lhWXSO).

“We have a responsibility to our patients and our community to make sure we are providing excellent pain control and using opioid-sparing methods to achieve that goal,” she said. “Regional anesthesia helps us do that.”

Regional anesthesia also decreases hospital length of stay. For instance, more complex procedures can be performed on an outpatient basis with advancements such as nerve block catheters, which allow for extended, patient adjustable, non-narcotic pain control via a small, portable elastomeric pump that infuses a local anesthetic, she added.

“Pain management is not one-size-fits-all, and patients appreciate the ability to have customized pain control,” said Dr Szlyk.

The speaker provided the audience with information about some regional anesthesia techniques, including peripheral nerve blocks and spinal anesthesia, which are the main types. Peripheral nerve blocks, often used during surgery on the extremities and other areas, involve the injection of a local anesthetic near a nerve or bundle of nerves. This process stops the patient from feeling pain in whatever area of the body that the nerve supplies. Spinal anesthesia involves the injection of a local anesthetic near the spinal cord and major nerves entering the spinal cord. This process blocks pain sensations from whole body regions (eg, lower abdomen, hips).

Dr Szlyk also covered the benefits of multimodal medications given with regional anesthesia as “an ideal pain management pathway for joint replacement patients.” The most commonly used multimodal medications (eg, cyclooxygenase inhibitors, acetaminophen, gabapentin) and adjuncts (eg, ketamine) for patients with chronic pain were mentioned in the presentation.

According to Dr Szlyk, regional anesthesia can also lead to substantial cost savings.

“The era of bundled payments has arrived and will increasingly impact care delivery,” she told Pharmacy Learning Network. “Regional anesthesia and its related cost savings continue to play a vital role in successful bundled payment initiatives,” she said. “Through advanced techniques such as ultrasound-guided nerve blocks and catheters, we are able to facilitate total joint replacements using Enhanced Recovery After Surgery (ERAS) protocols to reduce pain, decrease length of stay, improve ambulation and increase discharge to homedriving down costs and leading to overall higher satisfaction ratings.”

Dr Szlyk pointed out the importance of collaboration among interdisciplinary healthcare providers to “ensure the highest quality care within a value-based system.”

She explained that by including regional anesthesia as part of an ERAS pathway, successful multimodal pain management can be attained that both minimizes the patient’s opioid use and maximizes success in reaching his or her physical therapy goals.

“Our patients benefit from optimal outcomes within a cost-conscious environment,” she said.

The presentation also included information on patient and surgeon satisfaction with regard to regional anesthesia. According to the speaker, hospital administrators are supportive of the procedure. She noted that nerve block patients react positively to the pain management portions of many patient satisfaction surveys. They often recommend the hospital in such surveys, and also report fewer side effects, shorter hospital lengths of stay, reduced opioid-related adverse events, and earlier hospital discharges due to effective pain control, she said.

“With the evolving era of bundled payments, there is increased awareness about the importance of pain management and its impact on hospital readmission and discharge disposition,” she said. “Well-executed pain control can allow for patients to receive higher-quality care at a lower cost; this gets the attention of hospital administrators.”

The Interdisciplinary Conference on Orthopedic Value Based Care was held on January 21 and 22 in Newport Beach, CA.

“Now more than ever, we are integrating the historical silos of individual medical specialties and truly approaching patient care as a team,” said Dr Szlyk. “This conference was a tremendous forum for providers to effectively translate a shared goal of optimal patient outcomes into reality.”--Meredith Edwards White

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