Page 19 - CASA Bulletin 2019 Vol 6 No 4

Vol.6, No.4, 2019

It is also hard to assess pain under GA. Overall though TAP is good for postoperative pain,
with opioid reduction, especially minor procedures such as prostate; nonetheless opioid sparing

perioperatively needs much more aggressive multimodal acute pain management and regional

anesthesia techniques than just TAP. （李金蕾）

Discussion 3:10: Thanks for the wonderful expert opinions. Really enjoy the discussions. (Jack
Zhang)

Discussion 3:11: 谢谢李金蕾 的信息，提示减少术中镇痛药的使用 , 有可能反而增加术后

镇痛药的需要量！ (Baihan)

Discussion 3:12: Bai Han 好！ What is your experience at PA? My experience 主要是 PACU
needs for opioids can be paradoxically increased, overall opioid consumption with TAP is still

less or at least comparable for the duration of OR plus PACU, as well as for the entire hospital-

ization; if ntraoperative management is titrated to meet patient needs rather than merely avoid
opioids, TAP should help with PACU turn over. I had ERAS lap colectomy pts with a small dose

of dilaudid intraoperatively gave me a real laugh/ not much abdominal pain upon PACU arriv-

al. I think the major barrier here is providers sometimes forget what TAP can offer and can not
offer, especially if a supervising anesthesiologist leaves the decision of opioid administration to

whoever is in the room, and that person may or may not precisely understand the difference of

various types of blocks, surgical anesthesia block vs postoperative analgesia block, for example.
I also had ppl told me the blocks worked so well that pts had no response to surgical stimulation,

which goes back to the question of how to properly assess pain under GA. I told them if they do
not feel comfortable to give opioids during the surgery , they could start to get pt breath early,

then titrate opioids to RR around 10-15 at emergence, this strategy worked for some providers

and minimized PACU catch up on pain control. ( 李金蕾 )

Question 4: 李金蕾 , Do you do spinal block for the knee replacement plus adductor canal

block at the end of surgery? ( 唐越 )

Discussion 4.1: : 唐越 是的， All TKA and THA, are spinal intraoperatively; blocks are done

preoperatively though as we have a separate block team. ( 李金蕾 )

Discussion 4.2: Multimodal is the key. I use spinal duramorph plus introspective ketamine and

titrate small dose dilaudid at waking up has some good results. For cardiac surgeries, we use
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