At the 21st Annual Becker's ASC Conference in Chicago on Oct. 25, Peter G. Whang, MD, FACS, Associate Professor at the Spine Service Department of Orthopaedics and Rehabilitation at Yale University School of Medicine, shared new techniques for managing postoperative pain following orthopedic spinal procedures performed at ASCs.
Dr. Whang discussed how more and more complex surgeries have shifted to an outpatient setting due to advancements in minimally invasive procedures and improved anesthesia techniques, and how the shift has increased patient satisfaction and reduced overall costs.
Given the greater volume of surgeries, ASCs need to be ready to treat the postsurgical pain that often accompanies major procedures. The consequences of mismanaging postoperative pain can be severe for patients, including prolonged physical and psychological suffering, longer recovery times and hospital stays, higher instances of complications and more hospital readmissions.
As crucial as managing pain is for the well-being of the patient, it is also vital for the success of the ASC.
"Pain management is the only clinical marker assessed on the HCAHPS patient satisfaction survey," said Dr. Whang. "The HCAHPS results have a direct impact on reimbursement rates, so pain management could impact your bottom line."
The scores are also made publicly available online where they can be viewed by potential patients and ASC competitors.
Traditionally, postoperative pain has been managed with opioids, according to Dr. Whang. Opioids are effective and relatively inexpensive, although hidden costs of opioids can stem from managing opioid side effects, falls, longer hospital stays and, occasionally, treating patients who have developed a dependence on the drug.
Given the issues associated with opioids, new techniques have been developed to offer alternative pain management methods. Advancements include the use of:
- Preemptive analgesia to block noxious stimuli
- NSAIDs
- Gabapentinoids
- Epidural local anesthetics
- Epidural steroids
- Epidural opioids
- Continuous local infusion devices to release medication
- Injectable liposomal bupivacaine
According to Dr. Whang, one of the biggest changes in pain management going forward is likely to be a shift toward multimodal regimens in which different combinations of medications are administered to patients.
"Rather than the old model of giving patients weak opioids, then potent opioids, then more opioids to manage increasingly severe or lingering pain, a new approach of multimodal analgesia that uses two or more agents will increasingly come into play," said Dr. Whang.
In his opinion, multimodal analgesia may be safer, more effective, and give rise to greater cost savings than conventional regimens and should be considered by ASCs.