|
Post by katevaughn on Sept 30, 2018 17:26:49 GMT -5
This month’s journal club is presented by Jessica Switzman. She chose a great article that provides a review of opioid and nonopioid analgesics. Always an important topic to review and help us build our toolbox of many alternatives for analgesia. Here is a link to the article. The questions to encompass within your response: 1. How has the opioid shortage affected your practice? 2. What are you doing for spinals in the OR and OB with the shortage?
|
|
|
Post by Kristen Horsman on Oct 1, 2018 8:27:56 GMT -5
1. I have always used nonopioid adjuncts like Tylenol, ketorolac, gabapentin, ketamine when it is appropriate for the patient. While we were short on dilaudid for a while it was easy to use morphine as an alternative long acting narcotic. The only time my practice was altered was when it was very difficult to get remifentanil, especially in placed like JHOC. 2. CRNAs don't do any regional here at JHH so we are not as affected by this.
|
|
|
Post by Sue Kim on Oct 2, 2018 8:28:17 GMT -5
1. The value of using non-opioid medications such as acetaminophen, neurontin, toradol especially in the preoperatively period is very important and can potentially cut down on intraoperative opioid demand for the patient. The use of ketamine and precedex is also being considered more widely to help address intraoperative discomfort. The opioid shortage had definitely led me to think outside the box and use a variety of adjuncts to maximize patient comfort.
2. For our spinals, mainly for knee and hip replacements, we have been using 2% mepivicaine or ropivicaine (0.5% or 0.75%) - the latter mainly used for the longer hip or knee revisions in which we will place a CSE.
|
|
|
Post by kels on Oct 2, 2018 10:19:14 GMT -5
1. The opioid shortage has not really affected my practice.
There are so many benefits to decreasing the amount of opioids used during the perioperative period and non-opioid medications definitely plays a big role. Currently I am driven to use more non-opioid medications due to the national opioid over use and abuse crisis.
2. I do not work in OB and have not done a spinal in the OR for some time now.
|
|
kty67
New Member
Posts: 22
|
Post by kty67 on Oct 3, 2018 12:58:42 GMT -5
1. The opioid shortage did not really affected my practice. I always very cautious with narcotics by giving opioid during case to patient response. I use po Tylenol for most of my cases, add Toradol, Ketamine, Lidocaine for appropriate cases. 2. No regional cases in this facility.
|
|
|
Post by Ben Waldbaum on Oct 4, 2018 16:59:02 GMT -5
1.) Not very much. I always believed in a balanced anesthetic with opioids only being a part of the larger pain control plan. I am flexible and able to use whatever opioid is available.
2.) I rarely do spinals at JHH and have not been affected by the shortage.
|
|
|
Post by Jennifer Hannon on Oct 5, 2018 8:03:14 GMT -5
1) My practice did not change a whole lot as I do a lot of the ERAS cases in WBG, as you know, regional blocks/epidurals and low opioid administration is utilized in the protocol.
2) As mentioned above, no regional at Hopkins for the CRNA, however with the inaugural class of 2020, I hope this changes. I miss OB and regional.
|
|
|
Post by Lu Lin on Oct 8, 2018 7:09:50 GMT -5
1,the opioid shortage is not affect my practice much. I always try to do balance anesthesia and use combination of opioid and nonopioid medication.
2.we use 2% mepivicaine or ropivicaine (0.5% or 0.75%) for our joint caese during the shortage time.
|
|
|
Post by LarSharVeA Bennett on Oct 9, 2018 8:25:36 GMT -5
Prior to the opioid shortage, I had been more cognizant of the repercussions of opioids and the benefits of non-opioid analgesia; therefore, my judicious use of adjuncts remains the same. Like Ben, I use whatever opioid is available, so instead of hunting for dilaudid, I have no qualms about using morphine.
We do not do regional or OB.
|
|
|
Post by Moishe Mayer on Oct 15, 2018 12:34:53 GMT -5
1- The opioid shortage has forced us to use other modalities of pain management, and go out of our comfort zone. I typically, will us whatever is in my pyxus, in order to become proficient with all drugs.
2- I wish I did regional/OB
|
|
|
Post by Danielle Wallace on Oct 17, 2018 12:36:22 GMT -5
The opioid shortage challenges the anesthetist to find alternative ways to administer anesthesia while still meeting the patient's needs. Despite the shortage, we are still obligated to provide effective anesthesia. Therefore, I will use what's available and safe for my patients. There are a variety of drugs/analgesic adjuncts available that will decrease opioid requirements. I routinely incorporate Ofirmev and Toradol when appropriate for the patient. Nitrous Oxide has analgesic properties and its just a hand reach away.
2. CRNA's do not do regional anesthesia or OB.
|
|
|
Post by Jessica Hadley on Oct 18, 2018 15:21:02 GMT -5
1. The opioid shortage has not affected my practice too much. I am a proponent of multimodal analgesia and use adjuncts when appropriate. I also am fortunate that I am often in an orthopedic room that is utilizing regional techniques greatly reducing opioid requirements.
2. I have not had a patient under spinal in a long time, so can not answer this question.
|
|
nanci
Junior Member
Posts: 57
|
Post by nanci on Oct 23, 2018 17:37:35 GMT -5
1) The opioid shortage has not affected my practice to a noticeable level. At times the Remifentanil was not available but overall did not notice a shortage.
2) I have not done a spinal or OB here at Hopkins, so can not speak to if there is a shortage or how it is affecting the current system.
|
|
Kristen Praesel Lang
Guest
|
Post by Kristen Praesel Lang on Oct 24, 2018 10:21:40 GMT -5
1. How has the opioid shortage affected your practice? I wouldn't say that the opioid shortage has affected my practice on a major level (aside from the minor inconvenience of having to obtain remifentanil from the central pyxis for a short time for certain cases/patients). A multimodal approach to pain management likely mitigated the affect of the opioid shortage. Pre-meds and techniques like ERAS also help.
2. What are you doing for spinals in the OR and OB with the shortage? Sadly, I have not participated in a case requiring a spinal at JHH since the opioid shortage originated (no OB either). I am not sure what is being used at this time.
|
|
|
Post by Wai-Ling Lo on Oct 24, 2018 10:39:40 GMT -5
1. The opioid shortage hasn't affected my practice much because opioid is not the only mean for pain control. A combination of regional (in ERAS or orthopedic cases), multimodal analgesia (opioid and non-opioid adjuncts), and local anesthetics given by surgeon (if appropriate) helps to achieve pain control.
2. I don't do spinal and can't commend on this.
|
|