Excerpts from one of Dr. Fisk’s articles:
“Currently, temporary nerve catheters are only placed in an inpatient setting. However, there is significant precedent for discharging these inpatients with nerve catheters where they receive various levels of continued follow-up. These catheters usually stay in for no more than 3 days post-discharge and there is currently no way to replace them in the outpatient arena.”
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“Non-opioid pain medications, even commonly used classes such as NSAIDS, acetaminophen, and gabapentinoid anti-epileptics, are poorly understood and often under- and/or mis- utilized. These medications require close monitoring in the outpatient setting. Their pharmacology is complex. Finally, the literature is often conflicting and ever-changing. Different specialties tend to focus on particular aspects of the literature while remaining ignorant of other aspects. Perioperative acute pain specialist outpatient prescription and monitoring of these medications would be ideal in order to capitalize upon these medications fully while preventing serious complications.”
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“Ketamine infusions for pain management are also vastly underutilized on an outpatient basis, where they are occasionally used for severe, refractory depression and CRPS. Nonetheless, the effects of ketamine are known to outlast the actual infusion, its opioid sparing effects are well known, as are its profound analgesic properties. There is substantial potential for ketamine to help the outpatient perioperative patient including tolerance of painful rehabilitation and opioid weaning.”
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“Specific pain generators, such as bad knee or shoulder, make living without opioids especially difficult. Some patients simply cannot come down on opioids because in so doing, the severe pain they experience at a particular site in the body becomes too much to bear. These patients oftentimes need physical therapy to these parts of the body that can be far too painful to expect compliance. PRP and stem cell injection therapies are being developed that can accelerate the healing process within some of these pain generators as well. The specialized treatment modalities offered by acute pain specialists (ketamine, non-opioid analgesics, nerve catheters) can help lessen the pain in these areas while patients can focus on healing themselves with physical therapy, surgery, or injection therapies.”
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“Novel approaches to acute pain management are being developed. Ultrasound guided nerve localization is constantly improving. Longer acting, motor sparing nerve blocks utilizing modalities such as long acting lipid emulsion formulated local anesthetics, tunneled nerve catheters, temporary nerve cryotherapy, and indwelling nerve stimulators continue to evolve as well. The role of the acute pain physician in treating perioperative patients on an outpatient basis is imperative, but incredibly, almost non-existent. In fact, a central concierge for perioperative pain management for both opioid-dependent and opioid naïve patients simply does not exist, despite the ability for these specialists to provide the most profound short term analgesic options currently available.”