Perioperative Pain Control Tools For Surgeons

According to the Centers for Disease Control and Prevention (CDC), there were nearly 40,000 opioid-related deaths in the U.S in the last year alone. These numbers have increased considerably for a variety of reasons, and the growing role of prescription drug abuse has been widely recognized. There has also been increasing consciousness of the lack of dedicated and formalized training dedicated to prescription of analgesics, particularly among surgical trainees and practicing surgeons. Recent studies demonstrate that only a small minority of training programs mandates any opioid prescribing education, despite the fact that nearly all programs allow trainee prescription of opioids on an outpatient basis. Therefore, it is not surprising that despite a growing body of literature illustrating the value of opioid alternatives and adjuncts, practicing surgeons in all specialties largely ignore these evidence-based practices and continue to prescribe opioids in situations for which alternatives are proven, safe, and effective. There are many reasons for preparing a concise and practical resource describing evidence-based practices targeting surgeons and surgical subspecialists, including but not limited to: (1) The exponential increase in prescription drug abuse associated with the “opioid epidemic,” as surgeons play an important role in managing perioperative and chronic pain in a variety of practice setting; this issue bears importance from the patient, physician, and policymaker standpoint; (2) With increasing recognition of the role of quality improvement in patient safety initiatives, and literature demonstrating inadequate opioid prescribing education (OPE) in surgical training programs, it is only a matter of time before accreditation bodies including the ACGME incorporate strong recommendations and mandates for OPE; (3) Myriad literature demonstrating the existence of evidence-based alternatives to opioids – All surgeons and surgical subspecialists would benefit from a practical guide concisely laying this literature out. We feel that surgeons of all experience levels may benefit, ranging from the first year surgical intern to an experienced practitioner trying to remain compliant with the evolving opioid regulatory environment. Hence, the appropriate target audience for this text would be for the tens of thousands of current surgical trainees in many specialties, including general surgery, thoracic surgery, otolaryngology, plastic surgery, urology, gynecology, vascular surgery, neurosurgery, and orthopedic surgery. Furthermore, surgeons out of training would be another audience of interest, as there are increasing courses for continuing medical education based on perioperative and chronic pain management. Currently, there are no comparable and competitive guides with these target audiences; all of the existing literature about perioperative and chronic pain is targeted either specifically for patients, anesthesiologists, or pain medicine physicians. This will be the only up to date guide focusing on evidence-based practices for perioperative pain control, and each section will also include information on chronic pain sequelae relevant to each surgical specialty. The editors envision this text being an interdisciplinary endeavor, incorporating surgeons from multiple specialties, anesthesiologists, pain medicine physicians, and palliative physicians as appropriate.

The Handbook of Perioperative Pain Management is an up-to-date evidence-based guide to the effective management of perioperative pain even in the most challenging situations. It provides readers with an understanding of the physiology, pharmacology and psychology of acute pain together with guidelines for best practice. Examples of assessment documentation and guidelines for specific patient sub-groups are reproduced throughout the text.

All physicians are involved in the management of pain at some level or the other, but of the various specialties and health professions, surgeons are at the frontline of delivering perioperative pain care. Perioperative Pain Management for General and Plastic Surgery offers a concise yet comprehensive overview of the surgical pain management field to help practitioners effectively plan and enhance perioperative pain control. Chapters provide guidance on solving common dilemmas facing surgeons who are managing patients with pain related problems and clinical decision-making, and explore essential topics required for the trainee and practitioner to quickly assess the patient with pain, to diagnose pain and painful conditions, determine the feasibility and safety of surgical procedure needed, and arrange for advanced pain management consults and care if needed. This text also explores the latest evolving techniques and appropriate utilization of modern equipment and technology to safely provide care. Highly accessible and written by experts in the field, Perioperative Pain Management for General and Plastic Surgery is an ideal resource for practicing surgeons, anesthesiologists, critical care personnel, residents, medical students.

All physicians are involved in the management of pain at some level or the other, but of the various specialties and health professions, orthopedic surgeons are at the frontline of delivering perioperative pain care for a wide variety of problems that range from skeletal trauma, joint replacement procedures, bone tumors and spinal conditions. Perioperative Pain Management for Orthopedic and Spine Surgery offers a concise yet comprehensive overview of the surgical spine pain management field to help practitioners effectively plan and enhance perioperative pain control. Chapters provide guidance on solving common dilemmas facing surgeons who are managing patients with pain related problems and clinical decision-making, and explore essential topics required for the trainee and practitioner to quickly assess the patient with pain, to diagnose pain and painful conditions, determine the feasibility and safety of surgical procedure needed, and arrange for advanced pain management consults and care if needed. This text also explores the latest evolving techniques and appropriate utilization of modern equipment and technology to safely provide care. Highly accessible and written by experts in the field, Perioperative Pain Management for Orthopedic and Spine Surgery is an ideal resource for practicing orthopedic and spine surgeons, anesthesiologists, critical care personnel, residents, medical students.

Millions of procedures, surgical and non-surgical, are performed around the world each year. Management of perioperative pain is of great importance to patients, and a critical management issue for physicians and other health professionals who provide perioperative care. Healthcare facilities and national accrediting organizations have established standards surrounding proper management of perioperative pain. There is now an increased burden on every hospital and training program to ensure that healthcare providers understand the essentials of pain management and are able to recognize and treat pain in a timely fashion. Poorly controlled pain leads to patient dissatisfaction and contributes to increased morbidity and mortality, such as myocardial infarction, pneumonia, and emotional effects. Proper management, including appropriate pharmacologic management and regional analgesic techniques, can improve function and shorten length of hospital stay. Patients who are undergoing procedures under sedation or anesthesia need to receive adequate pain relief with drugs or regional anesthetic techniques. In the recovery room following the procedure, the staff taking care of the patient needs to be properly trained to diagnose and treat post-procedural pain. Part of the Oxford American Pain Library, this concise, evidence-based clinical guide serves as a tool for every clinician who wishes to understand the basic mechanisms, pharmacology, invasive and noninvasive treatment modalities, guidelines and development of pain management protocols. The authors address new technologies, chronic pain issues, running an acute pain service, opioid and non-opioid pharmacology (including newly approved drugs), epidural and other regional anesthesia, and special populations such as pediatric patients, the elderly, and patients with a co-existing disease.

The importance of effective and safe pain management in the perioperative period has never been greater. The populations clinicians serve are rapidly changing and, when considered in combination with socioeconomic issues, it is clear that the challenges of providing a high-quality perioperative experience are extensive. Fast Facts: Perioperative Pain provides a succinct and accessible guide to the practice of perioperative pain management, covering the complete surgical journey from the preoperative assessment phase through to postoperative management, including persistent postsurgical pain. Packed with detailed figures and illustrations, this valuable resource is suitable for all multidisciplinary team members who encounter surgical patients in pain during the course of their work. Table of Contents: • Pain mechanisms • Preoperative phase • Diagnosis and assessment • Multimodal strategies • Systemic therapies • Non-systemic therapies • Non-pharmacological management • Specific management strategies • Persistent postsurgical pain • Substance use disorder

Primum non nocere... The fact that a surgical procedure can leave any kind of pain casts a shadow over this tenet, which is seen as the basis of medical practice and anchor of its principle ethic... It is all the more surprising in that medicine has only paid attention to this paradoxical chronic pain situation for the past few years. Clarifying the knowledge acquired in this field has become all the more urgent for any care-giver today confronted by a legitimate request from patients: Why and how can a surgical procedure, which is supposed to bring relief, leave behind an unacceptable sequela? This is the approach which the contributors to this new subject of major clinical interest invite you to follow as you work your way through this book.

This book provides a comprehensive review of the challenges, risk stratification, approaches and techniques needed to improve pain control in ambulatory surgery centers (ASCs). It addresses not only the management of acute perioperative pain but also describes modalities that could potentially reduce the risk of evolution of acute pain into chronic pain, in addition to weaning protocols and follow ups with primary surgical specialties and pain physicians as needed. Organized into five sections, the book begins with the foundations of managing ASCs, with specific attention paid to the current opioid epidemic and U.S. policies relating to prescribing opioids to patients. Section two and three then explore facets of multimodal analgesia and non-operating room locations, including the use of ultrasounds, sedation in specific procedures, regional anesthesia, ketamine infusions, and the management of perioperative nausea and intractable pain in outpatient surgery. Section four examines the unique challenges physicians face with certain patient demographics, such as the pediatric population, those suffering from sleep apnea, and those with a history of substance abuse. The book closes with information on discharge considerations, ambulatory surgery protocols, recovery room protocols, and mandatory pain management services. An invaluable reference for all health personnel and allied specialties, Pain Control in Ambulatory Surgery Centers (ASCs) meets the unmet need for a resource that covers optimum pain control in patients undergoing outpatient surgery as well as the urgent ASCs challenges that are presented on an immense scale with national and international impact.