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Pre-operative surgery - Part II


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Part ll: The pre-operative surgery consultation
In part 1 we touched on the basics of surgery. In this blog, we will provide you with a more detailed understanding of the importance of a preoperative consultation.
Currently, Remedy Pain Solutions is teaming up with patients to maximize outcomes and minimize risks of their various types of upcoming orthopedic surgeries. Believe it or not, all of this can be accomplished in one visit using a multimodal, non-narcotic medication regimen. It is imperative that this team work begin before surgery though. The positive data behind our method is exuberant, yet, awfully underutilized and therefore underappreciated.
During your consultation you will be given verbal instructions as well as provided with a clear, easy to read direction sheet. A total of up to four medications will be provided to you. The most important thing to remember is that two of these medications need be started the night before surgery unlike most other pre-surgery instructions. Four medications may seem like a lot to some people but if you remember from part 1, we said that it is preferable to institute a multi-modal medication regimen rather than a single opioid or narcotic agent for pain relief. When compared to placebo, the use of this method demonstrates decreased subjective pain scores at the 1, 2, 4, 8, 12, and 24 hour marks following surgery which on average results in an 8mg per day reduction in opioid medications. Further, we see reduced incidences of nausea and itching from anesthesia, reduced incidences of chronic pain persisting after surgery, less anxiety before the procedure, and last but not least, more superior sleep quality and duration both before and after surgery. 
The reason this method is preferable also has a lot to do with the dangers of taking commonly prescribed pain medications like hydrocodone and oxycodone. In an acute setting, taking these opiates inhibits the production of our body's endorphins which are meant to help us naturally deal with pain. In the chronic setting, opiates not only inhibit the production of these endorphins, but also the receptors at which they bind to as well. Both demonstrate how the risk of developing a tolerance to opiates is possible and also accounts for their side effects including opioid induced hyperalgesia, addiction, respiratory suppression, constipation, and potentially overdose.
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