By Marti Webb Slay
There is currently a renaissance in pain management that is improving pain scores and decreasing hospital stays, according to Chris Godlewski, MD, MSHA, Associate Professor in the UAB Department of Anesthesiology & Perioperative Medicine.
“Now more than ever, anesthesiologists are in a position to make a positive impact,” Godlewski said. “With the advances in techniques and technology in anesthesia practice, we can do much more than just getting a patient through surgery safely: we can actually alter the trajectory of the operative and post-operative course.
“For many procedures, it’s the pain that keeps patients in the hospital. Now we are able to intervene pre-operatively and perform nerve blocks or tailor-made anesthetic plans that shorten hospital stays. Depending on the situation, we can sometimes get high-risk patients or those with difficult airways through cases without having to put them to sleep.
“In the seven years I’ve been at UAB, the regional anesthesia and acute pain management section has grown exponentially. When I started, there were days when we didn’t do any blocks. Now we could be doing 20-plus pain procedures in a day. We are favorably placed with the people and technology to do a lot of sophisticated perioperative procedures that can substantially impact the operative and post-operative course.”
The terms ‘regional anesthesia’ or ‘block’ can refer to a variety of approaches to treat pain and/or provide anesthesia, including a peripheral nerve block. Medicine can also be injected into the spinal fluid to help with post-operative pain, and nerve block catheters can stay in place for days, allowing patients to be more comfortable following surgery.
“From a hospital stay duration standpoint, another big source of dissatisfaction is nausea,” Godlewski said. “If we can do a nerve block and the patient doesn’t have to take as much opioid pain medicine, you can potentially cut down on nausea and other unpleasant side effects that opioid medications can cause, so it can be a far-reaching intervention.
“In older days we did procedures that were very dependent on the state of the patient’s coagulation status, which is dynamic and can always change. We are now figuring out ways to better and more safely serve these patients. We are getting better at being able to offer a wide array of services to more people.”
More anesthesia options and better pain management has benefits for both the patients and the hospitals. “There are surgeries that historically required patients to stay in the hospital, and now they no longer do,” Godlewski said. “That can alleviate strains on hospital systems, beds, and can allow medical staff to better address higher acuity patients and serve more citizens. It has long reaching effects.”
Pain management on the whole, in concert with nerve blocks, has made tremendous advances. For example, trauma patients with broken ribs and chest trauma can be tricky to take care of because opioids ease the pain, but suppress respiratory drive. “This can result in a patient being intubated for longer than we would like. We have been trying to find interventions to help these patients, and so far, we have some promising possibilities to provide pain relief and potentially facilitate removing the breathing tube” Godlewski said.
Reducing a reliance on opioid medications is important overall, particularly for patients who are recovering from addiction. “I had a gentleman a couple of weeks ago in solid recovery,” Godlewski said. “He didn’t want anything that could potentially jeopardize his recovery or cause a positive drug test. I offered to write a letter that he was having surgery, but if he had a positive test, he would be suspended while an investigation occurred. We got him through the surgery without giving him anything that would trigger a relapse or cause a positive drug screen.
“Most folks in good recovery are well-educated about their needs and are up front about volunteering the information we need to tailor make an anesthetic to them. Usually one of those regional anesthesia techniques is the bedrock of that, depending on what the surgery is.
“I often compare modern medicine to the iPhone. It’s moving along at such a blistering pace, that a year from now there’s a chance what we are doing right now may be on its way to obsolescence. It’s an exciting time to be practicing regional anesthesia and acute pain medicine.”