Last week, our community engaged in thoughtful discussions around surgical practices and patient safety. There was a strong focus on pre-operative care, with members sharing insights on pain management protocols. Another theme was the transition of care from the operating room to rehabilitation, highlighting the importance of seamless communication. We also saw a lively exchange of surgical safety knowledge through a fun trivia thread.
This Week’s Hot Topics
Talking pain and safety in pre-op
This thread delves into effective strategies for managing patient pain and ensuring safety before surgery. It’s an essential read for anyone looking to refine their pre-operative procedures. Read more here
Streamlining the OR-to-rehab handoff
Improving the handoff process from the operating room to rehabilitation can greatly enhance patient outcomes. This discussion explores best practices and common pitfalls. Read more here
Surgical safety checklist trivia
This engaging thread quizzes your knowledge on surgical safety checklists. It’s a fun way to refresh critical safety protocols. Read more here
Thanks for staying connected and contributing to these vital conversations. Your expertise and experiences are what make this community a valuable resource for all. Until next week.
Borrowed from ERAS, we added a pre-op bundle: 1 g acetaminophen + [redacted] celecoxib 60–90 min pre-incision, regional plan documented, and “no IV opioids pre-incision” unless rescue. The small win was a one-line handoff to rehab with block type and last PO dose, which cut first PT-session pain calls; I skip gabapentin in frail/OSA patients.
Big win for us was a pre-op “buprenorphine check” on med rec — if positive, we chart “continue bupe; multimodal plan” and auto-tag anesthesia and rehab so the handoff stays clean. @Guide this dropped PACU rescue calls; we still pull an anesthesia huddle for high-dose methadone or complex OSA.
I’ve had good results with a quick teach-back in the holding area: I tell patients, “the target is ‘comfortable enough to deep-breathe and walk,’ not zero pain,” and have them repeat it back. If someone’s very anxious or has low health literacy, I loop in @PT for a 2‑minute breathing/splinting demo; it adds a minute, but it consistently cuts overnight calls and surprise opioid requests — like sharpening the knife before cooking.
@ethan_morrison83, we added a quick STOP‑Bang at check‑in; if it flags OSA, the chart auto‑tags anesthesia/PACU and we default to an opioid‑sparing plan (scheduled acetaminophen + celecoxib and a block when feasible) — like putting a seatbelt on the pain plan. Small caveat: we skip celecoxib with eGFR <30 or ulcer history and avoid PCA unless “rescue only”; anyone else doing this?
On ortho days, I put in a pre‑op celecoxib 200–[redacted] order 1–2 hours before roll‑in; it’s consistently dropped our PACU opioid use and @anesthesia likes the platelet‑sparing profile. Small caveat: we skip it with renal disease, GI bleed risk, or fusion cases; if NSAIDs are out, a low‑dose gabapentin is our fallback per ERAS (https://erassociety.org/guidelines).
Quick win that’s been underrated: a clear carbohydrate drink finished 2 hours pre-op per ERAS — “no solids after midnight, but please finish the drink by T-2h” — has cut our PACU nausea and early opioid requests, and rehab gets moving sooner. I skip it in gastroparesis, poorly controlled diabetes, or emergent cases, and if PONV risk is sky-high I’ll add a pre-op scopolamine patch instead. @jmartinelli19 this also tightened our OR-to-rehab handoff because expectations are aligned before they hit PACU.
Echoing @bgrace77 offs: before the case we run a 60‑second ‘pain plan’ huddle with anesthesia that sets a realistic target (‘tolerable, not zero’), confirms home acetaminophen/NSAID timing, and auto-populates the first PACU orders — like setting the thermostat before leaving. Caveat: needs an interpreter for LEP patients, but it’s cut our opioid escalations.