Dr. Mindaugas Pranevicius, anesthesiologist and director of the pain management service at Jacobi Medical Center has taken a cutting-edge, multimodal approach to address this concern and provide safe anesthesia and prevent and manage pain.
“A new weapon in our defense against pain,” says nurse practitioner Denise Sullivan, a pain management specialist at Jacobi, “is a Bispectral Index Monitor, which ensures deep sedation and prevents operative awareness, a rare phenomenon in which a patient regains consciousness during surgery.”
The monitor’s sensor strip is taped to a patient’s forehead to measure brain activity. If the sensor registers less than 60, the patient is probably unconscious. A 100 indicates the patient is awake. Using this technology and monitoring the patient’s electrocardiogram, blood pressure, and heart rate, anesthesiologists can customize the amount of anesthetic the patient receives.
Research suggests customized anesthesia delivery results in patients waking up feeling more alert and with fewer anesthetic side effects, such as nausea and vomiting.
Surgical patients at Jacobi are interviewed by anesthesiologist Dr. Raghubar Badola on the same day they undergo pre-operative testing to discuss the anesthesia options available, with the safest, most effective technique provided, based on the patient’s preference, age and medical condition.
General anesthesia is just one of several options for anesthesia. Many surgeries at Jacobi Medical Center are performed using “regional” or “local” anesthesia, in which nerves to an arm or leg, for example, are chemically blocked, and the patient is unable to feel pain.
Local anesthesia allows a patient to remain awake and communicate during surgery, and results in fewer post-operative side effects than an operation using general anesthesia, in which a patient is rendered unconscious. The effects of local anesthesia last several hours after the surgery is completed, and longer if a continuous delivery system with the catheter is used.
Dr. Pranevicius promotes the use of regional anesthesia for many surgeries, especially orthopedic surgeries involving hip and knee replacements. Nerve block catheters are left in place for several days after surgery to keep the area of the operation numb and the patient comfortable.
As a result, less opioid medication is required, reducing the side effects: drowsiness, nausea, vomiting and constipation.
Relatively pain-free and wide-awake, patients are able to participate more fully in their physical therapy, and their recovery time is shortened.
“Faster recoveries make patients happy,” Sullivan says, “and helping patients maintain good pain control decreases the incidence of complications, such as acquired hospital infections, pneumonia, and chronic pain.”