Page 18 - CASA Bulletin 2019 Vol 6 No 4

CASA Bulletin of Anesthesiology

Discussion 3.3: Opioid surgical pain control is still the gold standard, but it should be individ-
ualized. The principle is adequate pain control, meaning minimizing side effect, minimal dose

and individualized, with multi modal approach.

There is no right or wrong answer. Different to surgery, different patient will require different

approach. That is what a physician should do and could do. That is where a physician’s value

is. ( 冯鸿辉）

Discussion 3.4: I think multimodality to control pain might be the trend. (Ning Miao)

Discussion 3.5: We had similar experience at our institution, so I did a small project on col-
orectal surgery, the results were: ERAS pts received significantly less opioids in OR and sig-

nificantly more in PACU than non-ERAS pts, similar amount as non-ERASpts if we combined

these two together. So by giving less even no opioids in OR saved nothing and only ended up
with paradoxically prolonged PACU stay. Overall less opioids for the entire hospitalization

though, which demonstrated the analgesic effect of TAP. I talked about this in our departmental

grand rounds and asked my colleague anesthesiologists /residents/CRNAs to titrate in 1/4-1/2
of the normal dose of opioids in pts who received TAP even with multimodal, as TAP is only a

somatic block, visceral pain is not controlled by TAP and needs opioids, just my 2 cents. ( 李金

蕾)

Discussion 3.6 :I think we are all on the same page that it is potentially harmful to continue
with this current knee jerk reaction toward opioids, as any drug, it is all about how to use it

wisely, as 冯鸿辉 nicely stated.

Discussion 3.7: One of my colleagues likes to do ESP block, she thinks it’s better than TAP
block for visceral pain control . ( 菊萍 )

Discussion 3:8 I have read one of your publications on tap block and narcotic use. Total

amount of narcotic uses despite of fast track or traditional discharge are similar. (Jack Zhang)

Discussion 3:9 :We moved away from TAP and use QLB/ ESP/paravertebrals, these have

more visceral coverage, still mostly a postoperative analgesia tool, not as good as neuraxial in
terms of intraoperative pain control, frequently a small dose opioid Intraoperatively is needed.

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