Back on their Feet Again

June 18, 2012
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    Tip of the Iceberg

     I have indicated on this website multiple times and in multiple ways that the superior post-operative analgesia provided by continuous nerve blocks has significant benefits. Patients can leave the hospital faster and more comfortable and with fewer side-effects from opioids. I would like to point out that they have a more rapid return to the activities of daily life (ADL) and demonstrate improved quality of life as well. For some patients, this may mean that they have adequate early post-operative nutritional intake and decrease the muscle and bone loss associated with inactivity. For others, it may be just returning to a relatively sedentary lifestyle free of nausea and constipation or lingering drowsiness and sedation. It isn’t really even a big deal anymore at our hospital to hear that total knee arthroplasty patients are going home on post-op day 2 commonly and that all of them are blowing away their rehabilitation ‘milestones’. Allowing patients to have an absence (or significant diminution) of pain and the side-effects of opioids is a great thing, but it is only the ‘tip of the iceburg’. With these problems of recovery out of the way (and a multidisciplinary recovery approach), patients are now able to realize significant leaps forward in their return to their regular lifestyle or to an improved lifestyle.

     Beyond this, there are a number of improved safety implications and financial gains that can be realized by the hospital. Every time a patient avoids or gets out of the ICU early, thousands of dollars are saved. The increased costs related simply  to ‘increased monitoring’ due to the need for significant doses of opioids and respiratory and cardiac depression is enormous. With Medicare clamping down more and more on what will be reimbursed -and how much facilities will get reimbursed, avoiding another UTI or pneumonia even here and there is a notable victory. Whenever a patient is able to have their Foley catheter removed a day earlier (or avoided completely), the incidence of UTI’s decreases. How can this happen? With continuous doses of local anesthetics, they are now alert and can walk comfortably to the bathroom, so we don’t need the Foley catheter anymore, thank you very much. Hospital Administrators, are you paying attention yet??? I haven’t even discussed the cost reductions with avoiding overnight stays and preventing readmissions due to inadequate analgesia or intolerance of opioid side-effects. Let alone the healthcare costs associated with persistent pain, AVF ‘maintenance’ or new implications in cancer spread and recurrence.

     Let me tell you about another positive financial implication for my own institution that I bet my administrators wouldn’t realize was significantly aided by the utilization of a continuous peripheral nerve block. I have run across numerous anecdotal cases of patients returning to work earlier due to the superior analgesia of their continuous nerve blocks, and this is the most recent awesome example of just that. Above is a picture of our very talented spine surgeon, Dr Robert Talac. Notice the fashionable ‘accessory’ over his shoulder and disappearing under his scrubs! He has given me permission to discuss his case and will even be doing a video testimony on this website in the near future about his recent experience. Dr Talac had an abdominal procedure and received bilateral continuous TAP blocks for his post-operative analgesia two days prior to this picture being taken. He has had minimal discomfort and has taken no opioids post-op. As you might imagine, I have another nerve block advocate at our hospital in Dr Talac! In this picture, he is on his way to the O.R. for a full case load less than 48 hours after his own procedure. That is good for Dr Talac and his patients, but keeping him in the O.R. for more cases this year will also be an added financial benefit to my hospital. Facilitating patients getting back to work quicker by improving the post-operative recovery period is an effect that you can have all over your community, and the linchpin to this entire process is in your hands. The time to get in the game is now!

Be sure to watch the video testimonial by Dr Robert Talac on the home page or surgeon’s testimonial section of this website!

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