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Post by Jocelyn Datud on Oct 25, 2018 13:22:52 GMT -5
1. The opioid shortage was a good avenue for me to try other medications. It made me more comfortable with utilizing pre-emptive analgesia and non-opioid medications in controlling pain. It is amazing to see how much we can make patients comfortable even without utilizing narcotics.
2. During the shortage we had been using mepivicaine or ropivicaine for spinals.
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Post by Belinda Gardner on Oct 26, 2018 9:25:38 GMT -5
1. Other than using Fentanyl instead of Hydromorphone (narcotic of choice for ERAS pathway) during the brief shortage or hunting for Remi minimal notice in my practice.
2. N/A
Using Lidocaine, Ketamine and Precedex drips more often in combination with other multi modal analgesics and neuraxial blocks has worked well to reduce our need to give narcotics in many cases specifically ERAS pathway and JHOC ortho cases.
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Post by Jackie Howell on Oct 27, 2018 10:43:40 GMT -5
1. I have always tried to utilize non-opioid adjuncts into my practice but the opioid shortage has made me maximize my efforts. I prioritize educating the patient in prepop to make sure they are well informed of all the alternative therapies we can offer them regarding post operative pain management to minimize opioid consumption (preop tylenol/gabapentin/celebrex, intra op use of LA/ketamine/magnesium, regional nerve blocks, epidural when applicable).
2. I don’t work in OB but at JH Bayview we are using 2% mepivacaine for uncomplicated primary knee replacements. Primary total hip replacements we either use 2% mepivacaine or 0.5-0.75% ropivacaine. Its nice to refresh ourselves that pka of local anesthetics are important for onset and potency is more related to lipid solubility. Mepivacaine should set up faster than bupivacaine but last shorter in duration since bupivacaine has a much more lipid soluble profile.
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Post by Meginnis on Oct 28, 2018 10:54:29 GMT -5
The opioid shortage hasn't affected my practice. As stated in multiple posts there are many other options to utilize when treating for pain. Also, can't comment on spinals or OB.
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Post by emedina1 on Oct 29, 2018 21:17:53 GMT -5
I wouldn't say that the opioid shortage has affected my practice in the eye center. Lucky for me our drug machine is always filled.Although in my administration of it ,i am hesitant when my patient has reached a certain amount that I think a bit more and the patient still comments the he is in pain. it is subjective feeling which i can not be judgmental. This is the time i think of multi modal pain treatment.
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Jennifer Pease Moreno
Guest
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Post by Jennifer Pease Moreno on Oct 30, 2018 14:18:44 GMT -5
1. My practice has not been greatly affected by the opioid shortage because I already use multimodal analgesia. It was difficult to obtain Remifentanil for a while. 2. I have not been involved in an spinal anesthetics for many years at Hopkins. I hope this changes.
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khall
New Member
Posts: 6
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Post by khall on Oct 31, 2018 8:14:51 GMT -5
1. The opioid shortage has caused me to order more long acting oral analgesics for PACU when appropriate.
2. I have not done a spinal since working here.
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Post by rboynton on Oct 31, 2018 14:21:56 GMT -5
1. At this point in time, the opioid shortage has not affected my practice too much. I use very small amount of opioids for most of my cases or will sometimes use Tylenol or Ketamine.
2. Currently, I do not do spinals.
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Post by C. Velarde on Nov 1, 2018 14:53:08 GMT -5
I think the IV Tylenol situation causes me to think that the rational to withhold the medications is foolish. The patient must be inpatient and only available in PACU status. If the patient feels better to go home, the IV Tylenol is a better choice than giving opiods in the PACU. There is no wait time no possibility of nausea or prolong PACU time. Currently we do not do spinals at JHU
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