Outpatient Surgery Magazine

Date Published: 
October 2002

Letters & Emails
Views on Containing Post-op Pain

Pre-emptive analgesia starts before the surgical incision and before the injection of the local analgesia (“New Ways to Contain Post-op Pain,” August, p. 24). Titrating a BIS-monitored propofol infusion to 70-75 before administering a 50-mg dissociative dose of ketamine is the critical component missing in all previous Level I studies of preemptive analgesia. Blocking the NMDA receptors with a dissociative dose of ketamine not only produces an immobile patient for the local analgesia injection but also sets the stage for genuine pre-emptive analgesia. My patients are routinely pre-oped with oral clonidine 0.2 mg and rofecoxib 50 mg 30-60 mg before induction. I have not used any opioids in my practice since December 1997 (without inflicting suffering in my patients).

The key to managing post-op pain is similar to managing post-op PONV — don’t cause it in the first place! Avoid emetogenic opioids for analgesia and precede the local anesthetic injection with a 50 mg dissociative dose of ketamine under adequate propofol hypnosis.

Barry L. Friedberg, MD
Cosmetic Surgery Anesthesia
Corona del Mar, Calif.

Website Development by Regency Web Service

Web Development by Nicholas Alipaz, in conjuction with Regency Web Service